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THE  PHARMACOPEIA 


A Series  of  Articles  which  Originally  Appeared  in  the  Journal 
of  the  American  Medical  Association,  Discussing  the  Chief 
Substances  in  the  United  States  Pharmacopeia,  Class- 
ifying Them  According  to  Their  Uses  and  De- 


By 

ROBERT  A.  HA.TCHER,  Ph.G.,  M.D. 

Assistant  Professor  of  Pharmacology,  Cornell  University  Medical  School, 
New  York 
and 


AND 


scribing  Their  Methods  of  Combination  and 
HowThey  May  Take  the  Placeof  Many 
Proprietary  Preparations  for 
Which  Extravagant  Claims 
Have  Been  Made. 


MARTIN  I.  WILBERT,  Ph.M., 
Apothecary  to  the  German  Hospital. 
Philadelphia 


CHICAGO : 

AMERICAN  MEDICAL  ASSOCIATION  PRESS 

1907 


QV  790. 

7 


Authority  to  use  for  comment  the  Pharmacopeia  of 
the  United  States  of  America,  Eighth  Decennial  Re- 
vision, IN  THIS  VOLUME,  HAS  BEEN  GRANTED  BY  THE  BOARD 
of  Trustees  of  the  United  States  Pharmacopeial  Con- 
vention, which  Board  of  Trustees  is  in  no  way  respon- 
sible for  the  accuracy  of  any  translations  of  the 
official  weights  and  measures,  or  for  any  statements 
as  to  strength  of  official  preparations. 


duke 

UNIVERSITY 

JUIV  e Z lyo4 
MEDICAL  CENTER 

le.rary 


Copyright,  1906,  by 
American  Medical  Association. 


\ 


CONTENTS 

PAGE 

Introduction  5 

General  Disinfectants  18 

Sunlight  and  Heat 19 

Chemical  Disinfectants  21 

Clinical  Thermometers  and  Hypodermic  Syringes . 29 

Local  Disinfectants  and  Antiseptics 32 

Mercurials  . . . 43 

Antisepsis  of  the  Mucous  Membranes 44 

Internal  Antiseptics  51 

General  Tonics  70 

Hematinics  71 

Alteratives  104 

Stomachics  118 

Astringents  13S 

Vegetable  143 

Metallic  14S 

Vasoconstrictors  156 

Irritants,  Emollients  and  Demulcents 159 

Rubefacients  160 

Vesicants  173 

Pustulants  179 

Caustics  180 

Emollients  183 

Local  Anesthetics  and  Anodynes 188 

General  Anesthetics  204 

Expectorants  219 

Sedative  221 

Stimulating  227 

Demulcent  234 

Analgesics  and  Soporifics 237 

Chemistry  of  Antipyretics 255 

Circulatory  Stimulants  204 


a $ I 5~ 


CONTENTS. 


PAGE 

Circulatory  Depressants  297 

Diuretics  and  Diaphoretics 309 

Irritants  314 

Cathartics  320 

Purgative  Oils  337 

Laxative  Sweet  Substances 339 

Saline  Cathartics  . . : 341 

Parasiticides  and  Antigonorrheics 353 

Anthelmintics  354 

Teniafuges  359 

Antigonorrheics  365 

Substances  Used  as  Vehicles 371 

The  National  Formulary  and  the  Use  of  Extraphar- 

macopeal  Substances  382 

Index  397 


THE  PHARMACOPEIA  AND  THE 
PHYSICIAN. 


INTRODUCTION. 

The  Pharmacopeia  of  the  United  States  of 
America  has  been  the  generally  accepted  authority 
and  the  professed  guide  of  American  medical  men, 
in  matters  therapeutic  and  pharmaceutic,  for  over 
eighty-five  years.  Since  the  publication  of  the 
first  edition,  in  1820,  the  book  has  undergone  eight 
decennial  revisions  and  to-day  it  is  universally 
conceded  to  be  the  peer  of  authoritative  books  of  its 
kind,  for  its  scientific  accuracy  as  well  as  for  the 
general  excellence  of  the  descriptions  and  direc- 
tions that  it  contains. 

This  recognized  superiority  of  the  Pharmacopeia 
of  the  United  States  of  America,  in  its  own  par- 
ticular field,  and  its  generally  accepted  authority, 
as  a guide,  in  all  matters  relating  to  the  strength 
and  purity  of  the  medicinal  articles  enumerated 
in  its  pages,  is  all  the  more  remarkable  in  that 
during  its  long  and  varied  career  it  has  never 
been  granted  a general  recognition  by  statutory 
enactment.  This  lack  of  legal  recognition  has  un- 
doubtedly been  a disadvantage  to  the  book  in  so 
far,  that,  in  the  past  two  decades  at  least,  the  con- 
tents and  even  the  very  existence  of  such  an  au- 
thoritative book  have  been  largely  lost  sight  of  ln- 
American  physicians,  and  official  remedies,  to  a 


6 


PHARMACOPEIA  AND  PHYSICIAN. 


very  marked  degree,  have  been  eclipsed  or  over- 
shadowed by  the  innumerable  patented  and  pro- 
prietary remedies  that  are  constantly  brought  to 
the  attention  of  medical  men  through  the  advertis- 
ing material  with  which  their  offices  are  regularly 
deluged. 

With  a view  of  bringing  the  Pharmacopeia  itself, 
its  scope  and  its  contents,  and  particularly  the  ex- 
tensiveness as  well  as  the  comprehensiveness  of  the 
included  material,  more  prominently  before  the 
medical  profession,  it  is  proposed  to  present,  in  the 
following  chapters,  a collection  of  facts  and  sug- 
gestions bearing  on  the  number  and  variety  of 
therapeutic  indications  that  may  be  fully  met  with 
official  drugs  and  preparations. 

It  is  also  proposed  to  call  attention  to  the  un- 
reasonable claims  and  the  extraordinary  statements 
that  are  frequently  made  in  connection  with  some 
of  the  arbitrary  combinations  of  drugs  that  are 
offered  as  proprietary  remedies  or  “patent”  medi- 
cines, and  to  compare  the  probable  limitations  of 
these  self-styled  panaceas  with  the  possible  applica- 
tion and  the  varied  uses  of  the  more  simple  and, 
therefore,  more  generally  reliable,  official  remedies, 
the  composition  as  well  as  the  purity  of  which  can 
readily  be  determined  by  well-known  and  easily 
applied  methods. 

That  even  the  most  recent,  the  eighth  decennial, 
revision  of  the  Pharmacopeia  can  not  be  said  to  he 
free  from  possible  errors  of  commission  and  omis- 
sion must  be  admitted,  but  many  of  the  shortcom- 
ings of  the  book  are  really  due  to  the  general  lack 


INTRODUCTION. 


of  interest  that  has  been  displayed  by  physicians ; 
and  many,  if  not  all,  of  these  shortcomings  should 
be  corrected  in  future  revisions,  if  members  of  the 
medical  profession  would  but  make  their  needs  and 
wishes  known  at  the  proper  time  and  place. 

It  has  been  repeatedly  asserted  that  the  Pharma- 
copeia of  the  United  States,  as  such,  is  designed 
primarily  for  pharmacists  and  for  the  manufac- 
turers of  pharmaceutical  galenicals,  and  that  it 
contains  little  or  nothing  of  direct  interest  to  the 
physician.  One  of  the  prime  objects  of  the  follow- 
ing chapters  will  be  to  demonstrate  that  this  asser- 
tion embodies  only  a half  truth  and  that  the  present 
edition  of  our  national  Pharmacopeia  really  con- 
tains much  that  does,  or  at  least  should,  interest 
every  medical  practitioner  in  the  land. 

In  this  connection  it  should  also  be  remembered 
that  the  technical  descriptions  and  tests  for  which 
the  average  physician  may  think  he  has  little  or  no 
use,  are  in  reality  essential  to  secure  for  him,  and 
through  him  for  his  patients,  remedies  that  are  not 
only  reliable,  but  which  are  also  uniformly  active. 

As  an  introductory  to  this  work,  it  may  be  per- 
missible to  give  a brief  review  of  the  history  of 
our  national  Pharmacopeia  and  incidentally  to  call 
attention  to  some  of  the  various  causes  that  have 
led  up  to  the  present  widespread  use  of  proprietary 
medicines  and  nostrums.  To  do  this  it  will  be 
necessary  to  call  attention  to  some  of  the  short- 
comings of  our  Pharmacopeia,  from  a medical 
point  of  view,  and  to  refer  to  at  least  several  of  the 


8 


PHARMACOPEIA  AX O PHYSICIAN. 


attempts  that  have  been  made  to  correct  these 
shortcomings  by  offering  either  a substitute  book 
or  by  introducing  more  or  less  radical  changes  in 
' the  book  itself. 

During  the  colonial  period,  and  even  during  the 
first  three  decades  of  the  independence  of  the 
United  States  the  pharmacopeias,  or  the  dispensa- 
tories that  were  based  on  the  pharmacopeias  of 
Edinburgh,  London  and  Dublin,  in  the  order  given, 
were  practically  the  only  authoritative  books  on 
materia  mediea  known  in  this  country. 

A rather  notable  exception  is  to  be  found  in  the 
small  pamphlet,  of  32  duodecimo  pages,  containing 
100  titles,  that  was  published  as  “A  Pharmacopeia 
for  the  use  of  the  Military  Hospital  belonging  to 
the  Army  of  the  United  States,”  during  the  Kevo- 
lutionary  period.  The  first  edition  of  this  little 
book  was  published  in  1778  and  a second  edition, 
bearing  the  name  of  Dr.  William  Brown  as  editor, 
was  printed  in  1781. 

The  earliest  known  attempt  to  produce  a dis- 
tinctly representative  American  Pharmacopeia 
was  made  by  the  members  of  the  College  of  Physi- 
cians of  Philadelphia,  who,  on  .June  1.  1788.  ap- 
pointed a committee  of  eight  members  to  form  a 
pharmacopeia  for  the  use  of  the  college.  The  mem- 
bers of  this  committee,  being  desirous  “that  the 
work  should  be  accommodated  to  the  practice  of 
medicine  throughout  the  United  States,"  contin- 
ued the  preliminary  work  and  correspondence  for 
over  ten  years,  but  finally  allowed  the  project  to 
languish. 


INTRODUCTION. 


9 


Recognizing  the  need  for  a more  distinctly 
American  book.  Dr.  J.  Redman  Cose,  of  the  Uni- 
versity of  Pennsylvania,  in  1806,  published  what 
was  practically  a reprint  of  Duncan’s  Edinburgh 
Dispensatory,  under  the  title  of  “The  American 
Dispensatory.”  The  nest  American  publication, 
in  point  of  time,  was  the  Pharmacopeia  of  the 
Massachusetts  Medical  Society,  published  in  1808, 
and  this  was  followed  in  1810  by  Dr.  James  Thach- 
er’s  American  New  Dispensatory,  also  published 
in  Boston.  These  books  supplied  two  of  the  then 
esisting  medical  centers,  and  the  territory  more  or 
less  dependent  on  them,  with  reference  books  on 
materia  medica,  of  American  origin.  The  territory 
more  directly  dependent  on  New  York  City  was, 
in  a measure,  supplied  by  the  publication  of  “The 
Pharmacopeia  of  the  New  York  Hospital.”  in 
1816,  and  the  subsequent  publication,  in  1818.  of 
an  American  reprint  of  the  Edinburgh  New  Dis- 
pensatory. This  rapid  multiplication  of  authori- 
tative books  appears  to  have  been  unsatisfactory 
and  no  doubt  led  to  the  revival  of  the  project,  pro- 
posed many  years  before,  of  forming  a truly  na- 
tional pharmacopeia. 

American  physicians,  and  particularly  the  lead- 
ers in  American  medicine,  have  contributed  so  lit- 
tle to  the  evolution  or  advancement  of  the  Pharma- 
copeia of  the  United  States  of  America,  during  re- 
cent decades,  that,  no  doubt,  it  will  be  interesting, 
if  not  surprising,  to  many,  to  be  reminded  of  the 
fact  that  the  inception  as  well  as  the  inauguration 
of  the  Pharmacopeia  is  to  be  accredited  to  the  lead- 


10 


PHARMACOPEIA  AND  PHYSICIAN. 


ing  minds  in  the  medical  profession  of  this  coun- 
try, eighty  or  more  years  ago.  It  was  at  a meeting 
of  the  Yew  York  County  Medical  Society,  in  Janu- 
ary, 1817,  that  Lyman  Spalding  suggested  the  first 
practicable  plan  for  securing  a national  pharma- 
copeia. At  the  annual  meeting  of  the  Medical  So- 
ciety of  the  State  of  Yew  York,  held  at  Albany,  in 
February,  1817,  the  same  plan  was  discussed  and  a 
committee  was  appointed  to  consider  the  necessary 
details  and  to  report  at  the  next  annual  meeting. 
The  report  of  this  committee  being  in  favor  of  the 
proposed  plan,  the  society,  in  1818,  appointed  dele- 
gates to  meet  in  district  convention,  for  the  pur- 
pose of  forming  a pharmacopeia.  Of  the  mem- 
bers of  the  Yew  York  State  Medical  Society  who 
took  an  active  part  in  forming  this  first  national 
pharmacopeia  it  may  be  well  to  mention  the  names 
of  Lyman  Spalding,  Samuel  L.  Mitchill,  David 
Hosack,  Valentine  Mott,  T.  Korneyn  Beck.  Wright 
Post  and  Alexander  H.  Stevens.  Other  members 
of  the  profession  were  hardly  less  enthusiastic.  In 
Boston  the  proposed  plan  received  the  earnest  sup- 
port of  John  C.  Warren,  Jacob  Bigelow,  James 
Thacher  and  George  C.  Shattuck.  In  Yew  Haven 
it  was  endorsed  by  Eli  Ives,  William  Tully  and 
Yathan  Smith;  in  Baltimore  by  Elisha  DeButts, 
Samuel  Baker  and  Yathaniel  Potter,  while  in 
Philadelphia,  Thomas  T.  Hewson,  Samuel  P.  Grif- 
fiths, Thomas  C.  James,  Edwin  A.  Atlee  and 
Joseph  Parrish,  all  of  them  active  and  influential 
members  of  the  College  of  Physicians,  gave  the 
plan  their  unqualified  support  and  endorsement. 


INTRODUCTION. 


11 


On  Jan.  1,  1820,  the  first  General  Medical  Con- 
vention was  convened  at  the  Capitol,  in  the  City 
of  Washington,  for  the  purpose  of  preparing  and 
publishing  a national  pharmacopeia.  The  conven- 
tion was  organized  by  electing  Samuel  L.  Mitchill, 
New  York,  president,  and  Thomas  T.  Hewson, 
Philadelphia,  secretary.  The  necessary  details 
connected  with  the  preparing,  publishing  and  edit- 
ing of  the  proposed  pharmacopeia  were  entrusted 
to  a committee  composed  of  Drs.  Lyman  Spalding, 
Thomas  T.  Hewson,  Eli  Ives,  Elisha  DeButts  and 
Jacob  Bigelow.  The  copyright  of  “The  Pharma- 
copeia of  the  United  States  of  America  was  sub- 
sequently sold  to  Charles  Ewer,  of  Boston,  “for  a 
large  sum”  and  the  book  was  finally  published  un- 
der date  of  “Dec.,  1820.’' 

This  completed  pharmacopeia,  although  pre- 
pared and  edited  by  a committee  of  the  most  promi- 
nent medical  men  of  the  day,  and  printed  in  Latin, 
as  well  as  in  English,  was  soon  found  to  be  “in  its 
nature  too  circumscribed  and  technical”  for  the 
use  of  physicians. 

To  overcome  this  objectionable  feature  and  to 
popularize  the  book  and  its  contents  with  medical 
practitioners.  Dr.  Jacob  Bigelow,  a well-known 
medical  writer  and  one  of  the  editors  of  this  first 
national  pharmacopeia,  in  1822,  published  what 
he  was  pleased  to  term  “A  Treatise  on  the  Materia 
Medica,  Intended  as  a Sequel  to  the  Pharmacopeia 
of  the  United  States,  Being  an  Account  of  the 
Origin,  Qualities  and  Medical  Uses  of  the  Articles 
and  Compounds  which  Constitute  that  Work,  with 


12 


PHARMACOPEIA  AYE)  PHYSIC  I A X. 


Their  Modes  of  Prescription  and  Administration.” 
This  book,  practically  a pharmacopeia  for  physi- 
cians, appears  to  have  met  with  considerable  popu- 
larity, and  the  well-worn  pages  of  the  still  existing 
copies  of  the  book  certainly  bear  evidence  to  the 
fact  that  they  were  frequently  consulted. 

That  a pharmacopeia,  consisting  largely  of  a 
simple  enumeration  of  drugs  with  detailed  direc- 
tions for  the  several  medicinal  preparations,  could 
not  be  expected  to  appeal  to  the  medical  profes- 
sion, and  that,  unless  such  a book  were  well  known 
to  the  individual  members  of  that  profession,  it 
would  have  little  or  no  reasonable  excuse  for  its 
existence,  appears  to  have  been  clearly  appreciated 
by  the  members  of  the  medical  convention  that  met 
in  the  city  of  New  York  in  January,  1830,  for  the 
purpose  of  revising  the  Pharmacopeia. 

The  members  of  this  convention  decided  to,  and 
subsequently  did,  introduce  several  really  novel 
features  into  this  first  revision  that  are  only  now. 
three-quarters  of  a century  after  the  publication  of 
the  book,  being  revived  and  discussed.  In  addition 
to  having  short  descriptions  of  the  physical  proper- 
ties of  drugs,  both  whole  and  powdered,  this  Phar- 
macopeia also  included  doses,  and,  what  is  even 
more,  also  included  short,  suggestive  remarks  on 
the  “Medicinal  Operations”  or  therapeutic  prop- 
erties of  the  several  drugs  that  were  included  in  the 
text. 

For  some  unknown,  and  certainly  unforeseen, 
reason  there  appears  to  have  been  a misunderstand- 
ing in  regard  to  the  method  of  electing  delegates 


INTRODUCTION' . 


13 


to  attend  the  General  Medical  Convention  and  at 
least  a portion  of  the  delegates  from  the  Middle 
States  did  not  attend  the  convention  in  New  York, 
but  decided  to  hold  a convention  of  their  own  in 
the  city  of  Washington.  As  a direct  outcome  of 
this  opposition  convention  we  have  another,  “first” 
revision  of  the  national  Pharmacopeia,  published 
in  Philadelphia  in  1831. 

This  1830,  Philadelphia  revision  of  the  na- 
tional Pharmacopeia,  as  it  is  generally  known,  was 
continued  along  practically  the  same  lines  as  the 
original  pharmacopeia  published  in  Boston  in  1820 
and  did  not  appear  to  meet  with  the  use  and  sale 
among  physicians  that  its  authors  expected. 

To  popularize  this  edition  of  the  pharmacopeia, 
and  also  to  furnish  American  medical  practition- 
ers with  a convenient  handbook  on  therapeutics, 
two  of  the  younger  members  of  the  committee  on 
revision,  Drs.  George  B.  Wood  and  Franklin 
Bache,  decided  to  prepare  and  to  publish  a com- 
mentary on  the  national  Pharmacopeia.  This 
book,  known  as  the  “Dispensatory  of  the  United 
States  of  America,”  first  published  in  1833,  met 
with  instantaneous  and  really  phenomenal  success. 
Three  editions  were  sent  to  press  within  as  many 
years  and  the  book  rapidly  displaced  the  Pharmaco- 
peia itself  with  both  physicians  and  apothecaries, 
and  led  to  the  rather  anomalous  condition  of  hav- 
ing a commentary  that  was  generally  accepted  as 
being  more  popular  and,  therefore,  more  important 
than  the  Pharmacopeia  itself. 

For  more  than  fifty  years  the  Pharmacopeia 


14 


PHARMACOPEIA  AND  PHYSICIAN. 


occupied  such  a secondary  and  comparatively  un- 
important position  to  the  Dispensatory  that  it  was 
generally  asserted  that  it  would  be  practically  im- 
possible to  have  the  Pharmacopeia  published  apart 
from  the  Dispensatory.  Fortunately  the  authors 
of  the  Dispensatory  were  men  of  exceptionally 
high  ideals  and  for  over  fifty  years  were  the  lead- 
ing contributors  to  the  advance  and  progress  of  the 
Pharmacopeia  itself. 

That  the  unrelenting  hand  of  time  brings 
changes  that  stay  progress  was  evidenced  in  1876, 
when  Dr.  E.  P.  Squibb,  of  Brooklyn,  called  the 
attention  of  the  members  of  the  American  Medical 
Association  to  the  fact  that  the  then  official  Phar- 
macopeia could  not  be  said  to  represent  the  existing 
status  of  the  practice  of  medicine  and  pharmacy. 
Dr.  Squibb  also  pointed  out  that,  owing  no  doubt 
to  the  death  of  one  of  the  editors  of  the  United 
States  Dispensatory,  Dr.  Franklin  Bache,  and  the 
very  advanced  age  and  practical  retirement  of  Dr. 
George  B.  Wood,  that  book  had  not  been  carefully 
revised,  or  brought  up  to  date,  and,  therefore,  that 
the  medical  profession  was  entirely  devoid  of  any 
authoritative  work  on  materia  medica  and  phar- 
macy. 

To  overcome  the  evident  stagnation  that  had 
crept  into  the  revision  of  the  national  Pharmaco- 
peia, at  that  time,  Dr.  Squibb  proposed  that  future 
revisions  be  undertaken  by,  and  conducted  under 
the  supervision  of,  the  American  Medical  Associa- 
tion. This  latter  proposition  met  with  such  active 
and  bitter  opposition,  however,  that  in  1S77  fur- 


INTRODUCTION. 


15 


ther  consideration  of  this  project  was  indefinitely 
postponed. 

During  the  decade  immediately  following  this 
discussion,  there  arose  a number  of  additional  fac- 
tors to  detract  from  the  popularity  and  from  the 
general  use  of  the  national  Pharmacopeia.  Xot 
the  least  of  these  is  to  be  found  in  the  innovations 
that  were  included  in  the  1880  (sixth  decennial) 
revision  of  the  Pharmacopeia  itself.  This  is  a sub- 
ject that  is  more  of  pharmaceutic  than  therapeutic 
interest,  however,  and  its  further  consideration 
may  be  omitted  at  this  time. 

One  other  factor,  and  not  by  any  means  an  un- 
important one  from  an  economic  point  of  view, 
was  the  introduction  of  German  synthetic  chemi- 
cals, and  the  accompanying  scramble  for  publicity 
by  ambitious,  professedly  progressive  medical  prac- 
titioners in  the  reading  pages  of  our  medical 
journals. 

Tvairin,  the  first  of  these  synthetic  products  to 
reach  us,  was  introduced  in  1883,  and  soon  proved 
to  be  not  only  unreliable,  but  positively  dangerous. 
It  was  followed,  in  1884,  by  antipyrin,  which  met 
with  phenomenal  use  and  added  untold  wealth  to 
the  coffers  of  the  manufacturer.  The  commercial 
success  of  this  substance  stimulated  others  to  re- 
newed activity,  and  in  the  succeeding  years  Ameri- 
can plrysicians  were  deluged  by  a number  of  really 
useful,  as  well  as  some  positively  dangerous,  syn- 
thetic remedies,  to  say  nothing  of  the  many  hun- 
dreds of'  elegant  pharmaceuticals,  all  of  them 
lauded  and  exploited  as  new  remedies. 


16 


PHARMACOPEIA.  AXD  PHY8ICIAX. 


This  rapid  accumulation  of  true,  as  well  as  of 
pseudo,  new  remedies  appears  to  have  had  a stimu- 
lating effect  on  the  editors  of  the  several  dispensa- 
tories and  text-books  on  materia  medica  and  thera- 
peutics. These  hooks  grew  rapidly  in  size  and  in 
the  variety  of  the  contained  material  until  the 
official  or  pharmac-opeial  portion  was  lost  in  the 
superabundance  of  wonderful  cures  and  remedies 
that  were  offered  for  the  alleviation  of  the  ill-  and 
ailments  of  the  human  family.  Added  to  all  this 
plethora  of  new  remedies  a feeling  of  therapeutic- 
nihilism  developed  until  it  was  quite  proper  for  a 
physician  to  disclaim  all  knowledge  of  the  use  of 
drugs  and  boldly  to  assert  that  he  was  entirely 
independent  of  the  necessity  for  such  really  anti- 
quated measures  as  drug  therapy. 

The  publication  of  the  1890,  or  seventh  decen- 
nial revision,  of  the  national  Pharmacopeia  offered 
or  suggested  but  little  change  in  the  then  existing 
conditions  other  than  to  reintroduce  the  long-es- 
tablished English  practice  of  measuring  liquids 
and  weighing  solids.  Even  this  concession  did  not 
appear  to  have  the  desired  effect  of  popularizing 
the  Pharmacopeia.  This  no  doubt  was  due  largely 
to  the  fact  that  pharmacists  are  proverbially  slow 
in  adopting  new  ideas,  and  physicians  are  even 
slower,  Or  are  loth,  to  insist  on  rational  innovations 
being  adopted  wherever  practicable. 

With  the  advent  of  .the  new  century,  there  ap- 
pears to  have  been  a re-awakening  on  the  part  of 
the  members  of  the  medical  profession,  at  least, 


INTRODUCTION . 


17 


and  the  interest  that  has  been  manifested  in  the 
work  of  the  Council  on  Pharmacy  and  Chemistry 
of  the  American  Medical  Association,  the  articles 
that  have  appeared  in  lay  journals  on  the  abuse  of 
nostrums  by  the  laity  and,  last  but  no  means 
least,  the  comments  that  have  appeared  in  medical 
journals  on  the  contents  of,  and  the  changes  that 
have  been  made  in,  the  recently  issued  eighth  de- 
cennial revision  of  the  Pharmacopeia  of  the  TJ  nited 
States  of  America  all  bear  evidence  to  the  existence 
of  a healthy  spirit  of  inquiry  among  medical  prac- 
titioners in  this  country. 

As  previously  noted,  it  is  our  present  purpose 
to  foster  and  aid  this  spirit  of  inquiry  and  to  pre- 
sent what,  at  times,  may  perhaps  seem  elementary 
and  well-known  facts.  If  we  succeed  in  making 
many  members  of  the  medical  profession  more 
familiar  with  the  drugs  .and  preparations  which 
are  included  in  our  national  Pharmacopeia,  we 
shall  feel  that  we  are  well  repaid  for  our  efforts. 


CHAPTER  I. 


GENERAL  DISINFECTANTS. 


The  important  subject  of  antisepsis  embraces  so 
many  different  agents  that  are  used  in  such  a va- 
riety of  conditions  that  any  convenient  considera- 
tion of  them  according  to  their  uses,  or  according 
to  the  principles  that  are  involved,  must  neces- 
sarily be  an  arbitrary  one.  For  our  purpose  we 
shall  consider  them  under  three  heads:  (1)  Gen- 

eral disinfectants  and  antiseptics;  (2)  local  disin- 
fectants and  antiseptics,  and  (3)  internal  antisep- 
tics. Some  substances  will  require  consideration 
under  all  three  headings,  but  even  this  will  be 
found  preferable  to  giving,  for  example,  all  of  the 
manifold  uses  of  such  an  article  as  mercuric  chlo- 
rid  in  one  place. 

Antiseptics  were  used  long  before  the  causes  of 
fermentation  or  of  putrefaction  were  known,  and 
it  would  have  been  remarkable  indeed  had  man 
failed  to  perceive  the  effect  of  those  substances 
which  are  capable  of  inhibiting  a process  so  com- 
monly encountered.  The  Egyptians  preserved  the 
human  body  against  the  attacks  of  putrefactive 
organisms,  without  any  evident  knowledge  of  the 
character  of  the  organisms  causing  decay,  by  means 
of  balsams  which  contained  such  antiseptics  as  ben- 
zoic and  cinnamic  acids.  The  epoch-making  dis- 
coveries of  Pasteur,  followed,  as  the}7  were,  by  the 


DISIXFECTAXT.S. 


19 


favorable  reports  on  the  use  of  phenol,  or  carbolic 
acid,  by  Lister,  and  the  subsequent  discovery  that 
other  substances  possessing  great  antiseptic  power 
were  even  less  toxic  to  man,  gave  tremendous  force 
to  the  pendulum,  which  was  carried  entirely  too  far 
by  the  efforts  of  well-meaning  enthusiasts,  and  in 
its  backward  swing  much  unnecessary  skepticism 
has  been  aroused. 

While  the  subject  of  general  disinfection  does 
not  necessarily  form  a part  of  the  physician’s  daily 
consideration,  there  are  occasions  when  he  is  sud- 
denly confronted  with  the  necessity  of  directing 
such  work,  and  on  the  thoroughness  with  which  he 
does  it  will  depend  the  safety  of  other  members  of 
the  community.  While  there  is  no  great  difficulty 
in  securing  thorough  disinfection,  it  is  absolutely 
necessarv  that  certain  rules  be  rigidly  complied 
with  and  this  can  not  be  done  without  an  exact 
knowledge  of  the  object  that  is  to  be  accomplished 
and  of  the  means  with  which  the  accomplishment 
is  to  be  brought  about.  There  is  probably  no  con- 
dition where  a little  knowledge  can  prove  to  be 
more  dangerous  than  in  this  very  matter  of  dis- 
infection, and  we  therefore  have  no  apologies  to 
offer  for  going  into  details  on  a subject  that  may  be 
considered  commonplace  or  well  understood. 

SUNLIGHT  AND  HEAT. 

The  best  of  all  disinfectants  is  bright,  direct 
sunlight,  coming  into  immediate  contact  with  the 
individual  germs,  not  merely  shining  on  one  side 
of  a thick  garment  or  carpet,  or  on  small  masses  of 
sputum,  blood,  pus  or  decaying  meat,  but  shining- 
on,  and  penetrating,  each  individual  micro-organ- 
ism. When  this  can  be  accomplished  all  germs — - 


20 


PHARMACOPEIA  AND  PHYSICIAN. 


not  all  spores — are  killed  in  a few  hours.  But 
sunlight  is  not  dependable  unless  all  of  the  neces- 
sary conditions  can  be  rigidly  complied  with,  as 
may  be  done  with  impervious  flat  surfaces  (floors), 
or  linen  and  other  thin  garments,  both  sides  of 
which  may  be  exposed  to  the  direct  rays  of  the 
sun.  The  disinfection  of  articles  infected  with  the 
more  virulent  pathogenic  organisms  usually  re- 
quires other,  more  directly  active,  means  than  that 
of  sunlight,  with  the  attendant  danger  of  further 
dissemination,  and  chemic  disinfectants  or  heat 
must  then  be  employed. 

The  direct  flame  instantly  destroys  all  forms  of 
microscopic  life.  Dry  air,  heated  to  160°  C.  (320° 
F.),  kills  all  disease  germs — but  not  all  spores— 
in  one  hour;  but  wood  will  begin  to  char  at  180° 
C.  (356°  F.)  and  even  lower,  so  that  dry  hot  air 
is  not  applicable  as  a certain  means  of  disinfection 
in  all  cases.  Simple  drying  kills  bacteria;  but 
masses  of  sputum  or  other  organic  matter  may  pre- 
serve the  organisms  in  the  interior  for  an  indefinite 
period,  while  spores  are  thus  preserved  for  years. 

Moist  heat,  water  or  air  saturated  with  aqueous 
vapor,  heated  to  75°  C.  (167°  F.),  is  rapidly  fatal 
to  most  bacteria.  Water  containing  typhoid  bacilli 
is  rendered  much  safer  by  heating  to  even  this 
comparatively  low  temperature  for  ten  minutes. 
Boiling  water,  on  the  other  hand,  will  kill  even 
spores  in  ten  minutes  or  more  if  they  are  not  pro- 
tected in  small  masses.  When  such  masses  do  exist 
1 per  cent,  of  soda  or  soap  should  be  added  to  the 
water  to  dissolve  the  albuminous  and  other  organic 
matter  and  at  the  same  time  to  raise  the  boiling 
point  slightly.  Metallic  instruments  do  not  rust 


DISINFECTANTS. 


21 


m water  containing  caustic  soda,  washing  soda, 
baking  soda  or  boras. 

Moist  steam,  or  air  which  is  supersaturated  with 
steam,  is  rapidly  fatal,  but  superheated  dry  steam 
is  not  so  quickly  fatal  as  is  the  moist  at  a much 
lower  temperature.  Pressure,  moisture  and  in- 
creased temperature  increase  the  effectiveness  of  all 
methods  of  disinfection.  Moist  steam  penetrates 
better  than  dry  air,  but  heavy  fabrics  may  protect 
micro-organisms,  and  particularly  spores,  for  a 
considerable  time,  and  many  articles,  such  as  mat- 
tresses, can  not  be  readily  disinfected  even  in  this 
way. 

CHEMICAL  DISINFECTANTS. 

Bedrooms  and  their  contents  may  be  disinfected 
by  the  now  official : 

Liquor  Formaldehydi. — U.  S. — Solution  of 
Formaldehyd,  containing  about  37  per  cent,  by 
weight  of  formic  aldehyd,  an  osyclation  product  of 
methyl  alcohol.  This  substance  may  be  applied 
directly  by  washing  or  spraying,  or  it  may  be  used 
in  the  form  of  vapor.  For  the  latter  purpose  the 
windows  and  doors  are  tightly  closed,  paper  being 
used  to  stop  up  the  crevices,  carpets  should  be  re- 
moved or  suspended  and  all  drawers  and  closets 
opened  and  their  contents  so  placed  that  the  vapor 
will  readily  reach  and  penetrate  every  particle  of 
fabric.  Formaldehyd  solution  is  then  vaporized 
either  in  the  room  or  through  the  keyhole  with 
enough  water  to  saturate  the  air  in  the  room.  Con- 
siderable loss  of  formaldehyd  occurs  through  de- 
composition during  vaporization  by  heat,  and  it  is, 
therefore,  preferable  to  saturate  sheets  with  the 
requisite  quantity  and  suspend  them  in  the  room 


22  PHARMACOPEIA  AND  PHYSICIAN. 

which  is  to  be  disinfected,  or,  better  still,  the  solu- 
tion may  be  sprayed  from  an  atomizer.  The  key- 
hole is  then  plugged  and  the  room  allowed  to  stand 
for  from  12  to  24  hours.  iSTovy  advises  150  c.e. 
(5  fl.  oz.)  of  the  40  per  cent,  solution,  correspond- 
ing to  about  165  c.c.  (5%  A-  oz.)  of  the  official,  for 
each  1,000  cubic  feet  of  air  space.  To  increase  the 
efficiency  of  the  formaldehyd,  3 liters  (3  quarts) 
of  water  are  vaporized  into  each  1,000  cubic  feet  of 
space.  If  the  atmosphere  is  damp,  less  water  will 
be  required,  of  course.  Under  ordinary  conditions 
it  is  cheaper  to  destroy  inexpensive  mattresses  than 
to  disinfect  them  thoroughly.  If  they  are  of  straw, 
destruction  is  more  readily  accomplished  by  burn- 
ing them  out  of  doors. 

Calx. — U.  S. — Lime,  calcium  oxid.  constitutes 
an  inexpensive  and  very  useful  disinfectant  that 
has  a number  of  widely  varying  uses.  Infected 
urine,  vomit  and  feces  may  be  thoroughly  disin- 
fected by  being  received  into  a vessel  that  contains 
freshly  prepared  milk  of  lime.  It  is  essential  that 
this  be  freshly  prepared,  as  calcium  hydrate  rapid- 
ly absorbs  carbon  dioxid  from  the  air  and  is  there- 
in’ changed  into  the  inactive  calcium  carbonate. 
Milk  of  lime  may  be  prepared  by  putting  a few 
pounds  of  lime  into  an  iron  pot  and  adding  about 
half  as  much  water;  the  lime  rapidly  falls  into  a 
dry  powder  with  the  evolution  of  heat : to  this  pow- 
der add  three  times  as  much  water  and  stir  well. 
The  resulting  mixture  will  keep  for  several  days 
without  deteriorating  sufficiently  to  be  inert.  There 
are,  of  course,  several  precautions  to  be  observed: 
The  lime  must  be  recently  calcined,  or  fresh,  and 
the  person  who  slakes  it  should  be  careful  to  avoid 
the  irritant  dust  which  arises  during  the  process; 


DISINFECTANTS. 


23 


then,  too,  the  heat  generated  may  be  sufficiently 
high  to  char  wood  or  to  set  fire  to  readily  combusti- 
ble materials.  For  disinfecting  feces  or  other 
substances  they  should  be  thoroughly  stirred  with 
an  equal  quantity  of  the  milk  of  lime,  or,  better 
still,  with  twice  the  quantity,  the  mixture  being 
allowed  to  stand  for  two  hours. 

Milk  of  lime  is  also  useful  for  disinfecting  floors, 
cellars,  cesspools  after  draining,  and  even  walls 
when  they  are  not  subject  to  injury.  It  must  al- 
ways be  remembered  that  this  whitewash  rapidly 
absorbs  carbon  dioxid  and  thus  becomes  inert, 
hence  the  mixture  is  an  efficient  disinfectant,  but 
is  not  useful  as  an  antiseptic. 

Unslaked  lime  is  a cheap  and  very  efficient  means 
of  destroying  animal  matter  and  is  also  useful  for 
absorbing  moisture  in  damp  cellars.  As  noted 
before,  certain  precautions  are  always  to  be  taken 
in  connection  with  this  realty  active  chemical  sub- 
stance. Cesspools  are  difficult  to  disinfect.  Large 
quantities  of  milk  of  lime  are  effective,  but  the  con- 
tents must  be  thoroughly  mixed  with  the  disin- 
fectant, whatever  its  nature. 

Hydrargyri  Chlortdum  Corrosiyttm.- — IT.  S. 
— Corrosive  Mercuric  Chlorid.  bichlorid  of  mer- 
cury, mercuric  chlorid,  or,  as  it  is  most  commonly 
called,  corrosive  sublimate,  will  be  considered  more 
extensively  in  connection  with  local  antiseptics.  It 
has,  however,  a number  of  very  important  uses  in 
connection  with  disinfectants. 

Corpses  of  persons  dead  of  an  infectious  disease 
should  be  immediately  wrapped  in  cloths  saturated 
with  a 1 to  1.000  solution  of  mercuric  chlorid.  The 
addition  of  20  per  cent,  of  glycerin  to  the  solution 
of  mercuric  chlorid  will  prevent  the  rapid  evapora- 


24 


PHARMACOPEIA  AND  PHYSICIAN. 


tion  of  the  water,  which  leaves  the  mercuric  chlorid 
as  a dry  powder  in  the  cloth.  Water  which  has 
been  used  to  bathe  a person  suffering  from  an  in- 
fectious disease,  such  as  typhoid  fever,  should  be 
disinfected  by  heating  to  near  the  boiling  point  or 
by  the  addition  of  a liberal  quantity  of  milk  of 
lime  or  a much  smaller  quantity  of  mercuric  chlo- 
rid. If  the  bathtub  is  of  metal,  the  latter  chemical 
should  not  be  used,  but  phenol  or  cresol  may  be 
substituted. 

Ferri  Sulphas. — IT.  S. — Ferrous  Sulphate, 
preferably  the  impure  or  crude  article,  commonly 
called  copperas,  is  an  excellent  deodorizer  for  ani- 
mal excretions,  the  iron  uniting  with  the  albumin 
and  the  acid  with  the  ammonia;  it  is  not  a very 
active  disinfectant. 

Cupri  Sulphas. — IT.  S. — Copper  Sulphate,  or 
blue  vitriol,  may  be  similarly  used,  but  it  is  much 
more  expensive  and  possesses  no  marked  advan- 
tages over  copperas  as  a deodorizer. 

Sulphur  Sublimatum. — IT.  S. — Sublimed 

Sulphur,  or  flowers  of  sulphur,  is  frequently 
burned  as  a disinfectant,  in  rooms  which  contain 
nothing  which  can  be  injured  by  the  corrosive  ac- 
tion of  the  resulting  sulphurous  oxid.  It  is  not  so 
frequently  used  now  that  formaldehyd  affords  a 
more  satisfactory  means  of  disinfection,  but  it  is 
cheaper  and  may  be  used  to  advantage  in  cellars 
and  in  empty  rooms,  that  can  be  thoroughly  sealed. 
Hoppe-Seyler  recommends  that  15  gm.  (Vo  oz.) 
be  burned  for  every  cubic  meter  (cubic  yard)  of 
space.  This  would  be  equivalent  to  about  450  gm. 
(15  oz.)  for  1,000  cubic  feet.  Rooms  should  be 
left  tightly  closed  for  from  twenty-four  to  forty- 
disinfected  by  heating  to  near  the  boiling  point  or 


DISINFECTANTS. 


25 


may  be  readily  absorbed  by  sprinkling  ammonia  in 
the  room.  As  with  formaldeliyd  disinfection,  the 
vapor  must  come  into  actual  contact  with  the  mi- 
cro-organisms and  the  atmosphere  should  contain 
moisture.  This  latter  requirement  is  usually  met 
by  burning  the  sulphur  in  a double  vessel,  the  outer 
one  containing  water. 

The  gas  that  is  generated  by  the  burning  of  sul- 
phur is  very  poisonous  to  man,  due  to  its  local  cor- 
rosive action.  Spasmodic  closure  of  the  glottis 
may  occur,  causing  death.  Sulphurous  oxid,  the 
substance  that  is  thus  generated,  remains  free  in 
mixtures  of  organic  matter  longer  than  free  chlo- 
rin.  hence  it  is  a more  effective  bactericide. 

Calx  Chlorinata. — U.  S. — Chlorinated  Lime, 
popularly,  though  improperly,  called  chlorid  of 
lime,  is  a ready  source  of  chlorin  and  is  a very  con- 
verdent  and  inexpensive  disinfectant  suitable  for 
many  of  the  purposes  for  which  sulphurous  oxid 
might  be  used.  Chlorin.  like  sulphurous  oxid,  is 
very  corrosive,  attacking  metals,  and  bleaching 
and  destroying  fabrics.  Chlorinated  lime  is  useful 
for  sprinkling  about  urinals,  damp  cellars,  out- 
houses, stables  and  drain*.  It  rapidly  deteriorates 
on  exposure  to  the  air  and  only  tightly  sealed 
packages  from  reliable  firms  should  be  used. 

The  various  solutions  of  clilorids  that  are  sold 
at  fancjr  prices  are  usually  feeble  and  are  in  nowise 
superior  to  a readily  made  mixture  of  a quarter  of 
a pound  of  chlorinated  lime  with  half  a gallon  of 
water.  The  admixture  of  an  acid  at  the  time  of 
using  causes  the  rapid  liberation  of  chlorin  and  in- 
creases the  disinfectant  action. 

Liquor  Sod^:  Chlorinat2e. — IJ.  S. — Solution 
of  Chlorinated  Soda,  the  so-called  Labarraque’s 


26 


PHARMACOPEIA  AND  PHYSICIAN. 


solution;,  is  but  another  form  of  a chlorin  com- 
pound. It  has  the  one  advantage  of  being  free 
from  insoluble  caustic  material.1 

Phenol. — U.  S. — Phenol,  the  Acidum  Car- 
bolicum  of  the  TJ.  S.  P.  1890,  is  much  more  ex- 
pensive and  not  nearly  so  efficient,  as  a disinfect- 
ant. as: 

Cresol. — IT.  S. — Cresol  has  been  included  in 
place  of  the  formerly  official  crude  carbolic  acid. 
It  is  a mixture  of  the  three  isomeric  cresols,  found 
in  coal  tar,  and  is  a useful  and  highly  efficient 
disinfectant  and  antiseptic. 

Liquor  Cresolis  Compositus. — U.  S. — Com- 
pound Solution  of  Cresol  consists  of  a mixture 
of  equal  parts  of  soap  and  cresol.  When  properly 
made  this  mixture  is  an  admirable  substitute  for 
any  one  of  the  numerous  soluble  or  semi-soluble 
proprietary  preparations  containing  cresol : such 
as  creolin,  cresolin,  lysol,  lysitol  and  a host  of 
others  too  numerous  to  mention. 

Compound  solution  of  cresol  is  practically  iden- 
tical with  the  Liquor  Cresoli  Saponatus  of  the 
German  Pharmacopeia;  it  is  miscible  in  all  pro- 
portions with  water,  and,  as  noted  before,  is  a re- 
liable and  readily  available  disinfectant. 


1.  Where  an  inodorous  deodorant  is  required  it  'will  be 
found  that  the  Liquor  Zinci  et  Alumini  Compositus  of  the 
National  Formulary  will  give  better  and  more  uniform  satis- 
faction than  proprietary  articles  of  the  same  type.  It  is 
made  as  follows  : 

R.  Zinci  sulphatis 

Alumini  sulphatis,  aa Sxxyii  100 

Naphthol  gr.  v 3 

Olei  thymi  gr.  xv  1 

Aqu®,  q.  s.  ad  Oi  500 

The  salts  are  dissolved  with  the  aid  of  heat  and  the  vol- 
atile substances  added  to  the  solution. 

Still  another  preparation  of  the  same  type  is  the  Liquor 
Zinci  et  Ferri  Compositus — N.  F. 


DISINFECTANTS. 


One  part  of  the  compound  solution  of  cresol 
added  to  twenty  parts  of  very  warm  water  is  useful 
for  the  sterilization  of  surgical  instruments,  and  a 
slightly  weaker  solution,  made  by  adding  one  part 
to  thirty  of  warm  water,  affords  an  excellent  disin- 
fectant for  the  hands. 

Potassii  Permanganas. — IT.  S. — Potassium 
Permanganate  attacks  all  forms  of  organic  matter 
and  is  generally  useful  for  the  destruction  of  foul 
odors,  but  is  not  very  useful  as  a disinfectant.  It 
will  be  considered  later  at  greater  length. 

The  strong  mineral  acids  are  destructive  to  bac- 
teria, but  their  application  as  disinfectants 
is  necessarily  very  limited.  As  noted  before, 
mercuric  clilorid  is  to  be  classed  with  the  most 
powerful  of  all  disinfectants  in  general  use,  one 
part  in  10,000  being  fatal  to  spores.  ' Like  all  other 
chemical  disinfectants,  its  activity  is  increased  by 
heat.  It  precipitates  albumin  and  its  efficiency  is, 
therefore,  materially  lessened  by  the  presence  of 
any  appreciable  amount  of  such  organic  material ; 
this  disadvantage  of  mercuric  chlorid  may  be  ob- 
viated in  part  by  the  addition  of  an  equal  amount 
of  sodium  or  ammonium  chlorid  (or  a small 
amount  of  hydrochloric  acid),  the  tablets  found 
on  the  market  for  preparing  the  solutions  always 
containing  the  requisite  quantity  of  one  of  those 
salts.  As  it  attacks  metals,  it  is  not  suited  for  the 
disinfection  of  instruments  or  metallic  vessels.  One 
part  of  mercuric  chlorid  in  50.000  parts  of  water 
has  been  demonstrated  to  possess  decidedly  anti- 
septic properties.  Its  comparative  non-volatility, 
its  property  of  attacking  metals  and  of  combining 
with  albumin,  and  its  extreme  toxicity  limit  its 


28 


PHARMACOPEIA  AST)  PHY  PIC  I AX. 


field  of  application,  but  it  remains  by  far  the  cheap- 
est antiseptic  we  have  for  general  use. 

Copper  sulphate  shares  with  copperas  (crude 
ferrous  sulphate)  the  power  of  deodorizing  decom- 
posing organic  matter,  though  it  is  but  little  used 
for  this  purpose.  It  has  recently  been  claimed  that 
the  merest  trace  of  copper  sulphate,  or  of  copper, 
in  water  readily  destroys  the  bacillus  of  typhoid 
fever,  or  at  least  completely  inhibits  its  growth; 
even  though  the  copper  is  present  in  quantities 
too  small  to  interfere  with  the  use  of  the  water  for 
drinking.  The  results  of  different  investigators 
are  not  uniform,  however,  and  some  maintain  that 
the  antiseptic  power  of  copper  and  its  salts  has 
been  greatly  overestimated.  The  soluble  salts  of 
zinc,  particularly  the  chlorid,  have  also  been  used 
for  disinfecting  purposes,  but  as  they  share  with 
copper  the  disadvantage  of  being  comparatively 
expensive,  without  any  accompanying  material  ad- 
vantages, a more  detailed  consideration  of  these 
substances  may  be  omitted  in  this  connection  2 

CLINICAL  THERMOMETERS  AND  HYPODERMIC 
SYRINGES. 

The  disinfection  or  sterilization  of  clinical  ther- 
mometers and  of  hypodermic  syringes  and  needles 

2.  The'  following  quotation,  taken  from  Wood's  “Thera- 
peutics,” page  823,  contains  suggestions  that  are  of  interest 
in  this  connection.  “There  are  not  many  affairs  in  life  in 
which  the  public  has  been  so  super-abundantly  fleeced  as  in 
the  matter  of  disinfection.  A most  extraordinary  part  of 
this  swindling  is  the  ease  with  which  distinguished  members 
of  the  medical  profession  have  given  certificates  of  efficiency 
and  value  to  comparatively  inert  and  extraordinarily  expen- 
sive proprietary  compounds.  . Oddly  enough,  the  cat  that  has 
drawn  the  chestnuts  out  of  the  fire  for  avaricious  manufac- 
turers has  not  even  had  the  sense  to  smell  the  odor  of  its 
own  paws  when  burning.”  It  is  evident  that  Dr.  Wood 
knew  less  of  the  resources  and  the  wiles  of  nostrum  makers, 
and  their  shrewdness  in  duping  physicians,  than  he  supposed, 
else  he  would  not  think  it  extraordinary  that  so  many  have 
been  deceived. 


DISINFECTANTS. 


29 


deserves  especial  mention.  With  the  present  com- 
paratively low  price  of  clinical  thermometers  there 
is  little  or  no  excuse  for  not  having  an  individual 
thermometer  for  each  patient  ill  with  an  infec- 
tious or  a contagious  disease  or  a continued  fever. 
But,  even  this  precaution,  desirable  as  it  certainly 
is,  does  not  obviate  the  necessity  for  disinfecting 
or  sterilizing  the  thermometer.  The  necessary  dis- 
infection may  he  effected  in  a number  of  ways,  the 
thermometer  may  be  dipped  for  a few  minutes  in 
strong  phenol,  the  solution  of  cresol,  or  in  the  now 
official  solution  of  formaldehyd,  after  which  it  is 
thoroughly  rinsed  in  water.  Where  an  individual 
thermometer  is  provided  it  may  be  sterilized  by 
keeping  the  bulb  immersed  in  75  per  cent,  alcohol, 
a saturated  solution  of  boric  acid,  the  official 
liquor  antiseptic-us.  or  in  a mixture  of  equal  parts 
of  antiseptic  solution  and  of  solution  of  hydrogen 
dioxid.  It  must  appear  even  to  the  least  careful 
that  the  disinfection  of  clinical  thermometers  is  a 
precaution  so  important  that  it  should  never  be 
neglected. 

The  hypodermic  syringe  and  needle  should  he 
disinfected  with  strong  phenol  or  cresol  solutions, 
solution  of  formaldehyd  or  by  repeated  washing 
with  very  hot  water,  as  a purely  routine  procedure, 
When  a syringe  and  needle  are  known  to  be  in- 
fected the  disinfection  should  be  as  thorough  as 
that  of  other  surgical  instruments. 

Solutions  intended  for  hypodermic  injection 
can  be  sterilized  by  boiling,  when  this  does  not 
cause  decomposition.  With  the  now  widely  used 
hypodermic  tablets  it  is  preferable  to  boil  the  nec- 
essary quantity  of  water,  or,  better,  distilled  wafer, 
for  a minute  or  two,  then  add  the  tablet,  avoiding 


30 


PHARMACOPEIA  AND  PHYSICIAN. 


all  'unnecessary  handling,  and  heat  sufficiently  to 
insure  thorough  solution.  Cocain,  being  readily 
decomposed,  can  not  be  boiled,  but  the  solution 
may  be  sterilized  by  heating  to  about  80°  C.  (176° 
F.)  for  thirty  minutes  on  two  successive  days.  It 
will  usually  be  found  to  be  preferable,  however,  to 
use  freshly  prepared  solutions  that  have  been  made 
in  a sterile  bottle  with  recently  boiled  and  sterile 
distilled  water.  Eucain  and  stovain  solutions  may 
be  boiled,  but  these  substances  themselves  are  not 
entirely  free  from  objections. 

Under  the  subject  of  internal  antiseptics  we 
shall  have  occasion  to  mention  the  disadvantages 
of  sterilized  milk,  but  here  we  may  call  attention 
to  the  widespread  use  of  formaldehyd,  salicylic 
acid  and  other  chemical  antiseptics  for  the  pres- 
ervation of  foods.  While  we  are  far  from  being  cer- 
tain that  minute  quantities  of  many  of  these  chemi- 
cal antiseptics  are  in  themselves  injurious,  we  have 
ample  authority  for  the  opinion  that  their  contin- 
ued use  in  appreciable  quantities  is  by  no  means 
beneficial.  Schmiedeberg  regards  the  constant  use 
of  even  small  quantities  of  salicylic  acid,  for  a con- 
tinued period,  as  unwise  in  the  present  state  of  our 
knowledge,  and  Sollmann  says  that  the  use  of 
formaldehyd  can  not  be  too  strongly  condemned, 
because  of  the  specific  irritation  of  the  mucous 
membranes  which  it  causes. 

The  whole  subject  of  food  preservatives,  how- 
ever, while  of  vital  importance,  is  one  in  which  the 
physician  should,  and  indeed  must,  be  actively  in- 
terested, but  it  is  entirely  too  extensive  to  be  dis- 
cussed at  length  here. 

The  subject  of  preservatives,  however,  is  also  of 
interest  in  connection  with  medicines  and  medici- 


DISINFECTANTS. 


31 


nal  preparations.  The  antiseptic  action  of  alcohol, 
glycerin,  sugar  and  of  volatile  oils  is  well  known 
and  generally  recognized,  and,  while  not  of  suffi- 
cient importance  to  lie  considered  in  connection 
with  general  disinfection,  these  substances  are 
widely  used  as  preservatives  not  alone  for  medici- 
nal preparations  and  foods,  but  also  for  other  sub- 
stances and  materials.  The  use,  or  abuse,  of  pres- 
ervatives in  connection  with  medicinal  prepara- 
tions, particularly  in  connection  with  proprietary 
remedies,  is  a matter  that  is  deserving  of  more  at- 
tention than  is  now  being  accorded  it;  as  the 
presence  of  preservatives  may,  and  undoubtedly 
does,  influence  the  physiologic  action  of  other  in- 
gredients. 


CHAPTER  II. 


LOCAL  DISINFECTANTS  AND  ANTISEP- 
TICS. 

Lister’s  use  of  local  antiseptics  in  surger}r  is 
usually  spoken  of  as  a discovery,  but,  without  de- 
tracting in  any  way  from  the  credit  due  to  Lister, 
it  should  be  referred  to  more  correctly  as  a prac- 
tical application  of  previous  discoveries. 

Reichenbach,  in  1832,  obtained  a substance  from 
wood  tar  which  he  named  creosote.  Finding  later 
that  it  consisted  of  phenol  and  phenol  ethers,  and 
also  finding  these  same  substances  in  smoke,  he 
concluded,  and  later  conclusively  proved,  that  to 
them  is  due  the  meat  preserving  activity  of  smoke. 

Runge,  in  1834,  found  that  the  phenol  which 
he  obtained  from  coal  tar  also  possessed  the  power 
of  preventing  putrefaction.  Tar  and  a number 
of  products  of  a similar  nature  were  long  ago  rec- 
ommended and  widel}’  used  for  foul  smelling  ul- 
cers, but  the  fact  remains  that  to  Lister  is  univer- 
sally. and  very  properly,  accorded  the  distinction 
of  having  placed  antisepsis  in  surgery  on  a sure 
basis.  Since  the  early  days  of  antisepsis  there 
have  been  many  improvements,  and  we  now  know 
that  the  most  perfect  cleanliness,  or  asepsis,  that 
is  attainable  is  much  to  be  preferred  even  to  the 
most  elaborate  antisepsis. 

It  is,  of  course,  entirely  beyond  the  scope  of 
this  treatise  to  consider  the  details  of  major  surg- 
ery, but  the  principles  of  antisepsis  which  obtain 
in  this  branch  are  equally  applicable  to  minor 
operations,  and  their  disregard  by  many,  who  are 


LOCAL  ANTISEPTICS. 


33 


not  surgeons,  is  the  best  justification  for  their 
present  brief  consideration.  The  necessity  for 
scrupulous  cleanliness  is  seen  in  such  a common, 
but  admittedly  important,  procedure  as  vaccin- 
ation. The  careful  physician  will  perform  even 
this  simple  operation  under  aseptic  conditions, 
thereby  saving  himself  much  annoyance  in  case 
of  accident. 

The  first,  and  really  the  most  important,  duty 
of  the  physician  with  regard  to  infections  is  to 
see  that  he  does  not  carry  them  to  other  patients. 
There  can  be  no  doubt  that  physicians  have  played 
no  small  part  in  the  spread  of  infectious  diseases, 
particularly  in  the  past,  but  fortunately,  with  the 
better  understanding  of  the  subject,  this  seldom 
occurs  now. 

The  disinfection  of  clothing  and  of  instruments 
belongs  to  the  subject  of  general  disinfection,  that 
of  the  hands  and  person  to  local  disinfection. 

The  cleansing  of  the  hands,  as  it  is  done  in  a 
number  of  American  hospitals,  is  about  as  fol- 
lows : “Trim  and  clean  the  nails,  wash  the  hands 
and  forearms  for  five  minutes  in  very  warm, 
sterile  water,  using  green  soap  and  scrubbing 
them  energetically  with  a brush  or  a gauze  pad, 
cleansing  the  nails  again  during  this  part  of  the 
process.  Rinse  the  hands  for  three  minutes  in  75 
per  cent,  alcohol,  to  remove  soap  and  to  aid  in 
sterilization ; then  in  1 to  1,000  solution  of  mer- 
curic chlorid,  or  in  a solution  of  1 to  2,000  mer- 
curic chlorid  with  1 to  40  phenol,  and  finally 
rinse  in  sterile,  warm  water.”  This  may  be  some- 
what more  elaborate  than  is  necessary  in  most 
cases  of  minor  surgery,  but  even  here  it  is  well  to 
err  on  the  safe  side. 


34 


PHARMACOPEIA  AND  PHYSICIAN. 


For  the  disinfection  of  the  whole  body  a full 
bath  in  warm  water  with  the  liberal  and  judicious 
use  of  soap  is  sufficient,  and  the  clothes  may 
undergo  disinfection  separately  at  the  same  time. 
This  procedure  is  so  simple  that  the  physician 
can  not  escape  blame  should  he  carry  infection 
from  one  patient  to  another  through  the  omission 
of  necessary  precautions. 

When  minor  surgical  operations  are  to  be  per- 
formed it  is  always  well  to  thoroughly  disinfect 
the  surface  at  and  around  the  prospective  seat  of 
operation.  For  this  purpose  the  procedure  given 
for  cleansing  the  hands  of  the  surgeon  is  sufficient, 
though  in  some  cases  it  may  be  found  necessary 
to  supplement  the  soap  and  water  with  oil  of 
turpentine. 

Wounds  and  ulcers  require  disinfection  to  de- 
stroy those  bacteria  which  can  be  reached,  and 
antiseptic  dressings  to  prevent  the  development  of 
colonies  from  those  which  escape  destruction  or 
which  may  afterward  reach  the  spot. 

Aqua  Hydrogenii  Dioxide — TJ.  S. — Solution 
of  Hydrogen  Dioxid,  or,  as  it  is  frequently  called, 
Solution  of  Hydrogen  Peroxid,  is  useful  for  de- 
composing pus,  in  which  bacteria  are  protected 
from  the  action  of  other  disinfectants.  It  thus 
secures  the  rapid  cleansing  of  freely  exposed  pus 
cavities  or  ulcers,  and  at  the  same  time  it  acts 
powerfully  on  bacteria,  though  they  are  not  all 
destroyed  so  long  as  any  pus  remains.  The  offi- 
cial solution  is  equal,  in  disinfectant  power,  to  a 
1 to  1,000  solution  of  mercuric  chlorid.  The  ac- 
tion on  pus  of  hydrogen  dioxid  is  so  extremely 
rapid  that  it  frequently  detaches  small  masses 
which  may  escape  decomposition. 


LOCAL  ANTISEPTICS. 


35 


The  use  of  this  solution  is  not  unattended  with 
risks,  particularly  in  sinuses  or  deep,  partially 
closed  wounds.  Mucous  membranes  decompose 
hydrogen  dioxicl  rapidly,  and  the  skin  slowly,  with 
the  liberation  of  nascent  oxygen.  It  is  not  certain 
whether  the  bactericidal  property  is  due  to  the 
liberation  of  oxygen  alone,  or  whether  the  prepara- 
tion possess  a special  influence  on  the  micro-organ- 
isms. The  decomposition  whereby  the  oxygen  is 
liberated  is  supposed  to  depend  on  a ferment, 
catalase,  which  is  widely  distributed,  and,  as  the 
preparation  loses  its  bactericidal  powers,  once  the 
oxygen  has  been  liberated,  it  is  of  course  useless 
as  an  antiseptic,  though  extremely  -useful  as  a 
disinfectant.  Hydrogen  dioxid  has  an  especial 
reputation  in  the  treatment  of  sore  throat  and 
even  diphtheria,  for  which  it  is  used  as  a spray, 
or  as  a gargle  with  entire  safety.  It  attacks  met- 
als readily,  and  only  rubber  or  glass  should  be 
used  in  connection  with  it.  Diluted  with  an  equal 
amount  of  water,  it  is  an  excellent  mouth  wash, 
but  not  infrequently  contains  a little  acid,  and  the 
mouth  should  be  rinsed  after  its  use.1 

After  the  disinfection  of  ulcers  and  wounds  an 
antiseptic  dressing  is  applied.  -Cotton,  gauze  and 
lint  impregnated  with  various  antiseptics  are 
found  on  the  market.  Only  the  active  substances 
that  are  used  iu  this  connection  will  be  discussed, 
as  the  application  of  dressings  belongs  to  surgery. 

Iodoformum. — U.  S. — Iodoform,  Tri-iodome- 
thane  is  usually  obtained  by  the  action  of  iodin 
on  alcohol,  in  the  presence  of  an  alkali  or  an  al- 

1.  An  agreeable,  and  at  the  same  time  efficient,  mouth 
wash  is  obtained  by  mixing  equal  parts  of  aqua  hydrogeni: 
dioxidi,  liquor  antisepticus  (U.  S.)  and  a saturated  solution 
of  potassium  chlorate. 


36 


PHARMACOPEIA  AND  PHYSICIAN. 


kaline  carbonate.  Iodoform  was  discovered  by 
Serullas,  in  1822,  but  was  not  used  in  medicine 
until  some  time  after  1837.  Despite  its  disagree- 
able penetrating  odor,  iodoform  continues  to  bold 
first  place  among  local  antiseptics,  used  for  tbe 
dressing  of  wounds.  At  first  it  was  supposed  to 
share  with  chloform  (from  which  it  differs  chem- 
ically only  in  the  iodin  displacing  the  chlorin)  a 
strong  antiseptic  action,  but  in  the  case  of  iodo- 
form, this  has  been  found  to  be  but  slight;  it  is, 
however,  materially  increased  by  the  slow  libera- 
tion of  iodin.  When  its  local  use  as  a dressing  is 
long  continued,  enough  of  it  may  be  absorbed  to 
produce  poisoning,  which  does  not,  however,  re- 
sult in  typical  narcosis,  such  as  chloroform  pro- 
duces, but  gives  rise  to  disturbances  of  cerebration, 
headache,  delirium  and  other  symptoms.  These 
are  due  to  the  iodoform  molecule;  but  exanthem- 
ata, which  are  sometimes  severe,  are  usually  attri- 
buted to  the  liberated  iodin,  which,  when  liberated, 
is  thought  to  circulate  in  the  blood  as  an  alka- 
line iodid  or  in  combination  with  albumin.  Hem- 
aturia, albuminuria  and  urinary  casts  may  also  re- 
sult from  its  absorption,  and  many  attempts  have 
been  made  to  find  a substitute  for  iodoform  with- 
out its  poisonous  effects. 

Some  surgeons  deny  that  iodoform  exerts  any 
direct  antiseptic  power,  and  attribute  the  bene- 
fits from  its  use  to  its  limitation  of  the  secretion 
on  which  the  bacteria  would  otherwise  develop. 
Binz  observed  that  iodoform  lessened  the  emigra- 
tion of  leucocytes,  and  it  is  said  to  be  particularly 
useful  in  local  affections  with  free  secretions. 

When  iodoform  is  intended  for  use  as  a dust- 
ing powder,  its  odor  may  be  rendered  venr  much 


LOCAL  ANTISEPTICS. 


37 


less  disagreeable  by  incorporating  with  it  from  1 
to  4 per  cent,  of  cumarin.  The  following  has 
been  used  to  some  extent: 


IJ.  Iodoformi  3v  20 1 

Cmnarini  gr.  xv  1| 

Acidi  borici  q.  s.  ad oxiii  50 1 


Misce.  bene.  Sig. : To  be  used  as  a dusting  powder. 

Pulvis  Iodoformi  Compositus  (1ST.  F.),  contain- 
ing iodoform  20,  boric  acid  30,  naphthalin  47, 
and  oil  of  bergamot  3 parts,  also  constitutes  a use- 
ful and  comparatively  unobjectionable  antiseptic 
dusting  powder. 

Where  iodoform  is  to  be  used  in  the  form  of  an 
ointment  the  addition  of  from  5 to  10  per  cent,  of 
balsam  of  Peru,  or  of  2 per  cent,  of  oil  of  anise 
has  been  found  to  be  advantageous.  The  addition 
of  oil  of  anise,  in  somewhat  larger  quantities,  has 
also  been  recommended  for  iodoform  gauze,  par- 
ticularly' when  the  gauze  is  to  be  used  in  appre- 
ciable quantities  or  for  any  continued  length  of 
time.  If  the  antiseptic  action  of  iodoform  is  due 
to  the  liberated  iodin,  then  necessarily  many  of 
the  proposed  substitutes  must  be  practically  de- 
void of  antiseptic  power,  since  the  iodin  is  too 
firmly  bound  to  be  liberated  by  the  tissues. 

Iodolum. — U.  S. — Iodol  designated  chemically 
as  tetra-iodopyrrol,  one  of  the  recent  additions  to 
the  Pharmacopeia,  illustrates  this  particular  condi- 
tion very  well.  The  iodin  in  this  case  is  so  thor- 
oughly combined  that  the  substance  has  been  rec- 
ommended as  being  comparatively  non-toxic.  An- 
other class  of  preparations,  such  as  nosophen,  loso- 
phan  and  europhen,  depends  for  the  antiseptic 
action  largely  on  the  cresol  or  the  phenol  com- 
pounds united  to  the  iodin.  Loretin  and  vioform 


38 


PHARMACOPEIA  A ND  PHYSICIAN. 


are  combinations  of  iodin  and  quinolin,  and  there 
is  no  reason  to  suppose  that  they  have  any  advan- 
tages over  the  other  preparations  just  mentioned. 

Thymolis  Iodidum. — U.  S— Thymol  Iodid 
much  better  known  by  the  formerly  trade-marked 
name  “Aristol,”  is  a condensation  product  of  two 
molecules  of  thymol  with  two  atoms  of  iodin,  and 
more  properly,  therefore,  should  be  designated  by 
its  true  chemical  title,  dithymol  di-iodid.  This 
preparation,  which  really  belongs  to  the  phenol 
group  of  iodin  compounds,  has  met  with  a better 
reception  than  many  of  the  other  iodoform  sub- 
stitutes. It  is  probable,  now  that  the  patents  have 
expired  on  aristol  and  the  substance  is  available 
at  much  more  reasonable  prices,  that  its  popular- 
ity and  use  will  be  extended  still  further.  This, 
however,  is  problematic.  Schmiedeberg  specifi- 
ally  states  that  aristol,  losophan,  sozoiodol.  picrol, 
loretin  and  antiseptol,  all  of  which  contain  iodin, 
are  not  more  actively  antiseptic  than  are  the  cor- 
responding iodin  free  compounds,  while  the  latter 
are,  of  course,  much  less  expensive.  Since  the 
number  of  possible  combinations  of  this  tjqrn  is 
practically  unlimited,  we  will  do  well  to  exercise 
circumspection  in  accepting  those  which  appear 
from  time  to  time. 

Phenol. — U.  S. — Acidum  Carbolicum  (U.  S. 
P.,  1890)  is  hydroxy  benzene,  and  may  be  obtained 
from  coal  tar  by  fractional  distillation  and  subse- 
sequent  purification,  or  may  be  made  synthetically. 
In  its  pure  state  it  occurs  as  colorless,  needle- 
shaped  crystals,  or  as  a white  crystalline  mass. 

Phenol  Liqijefactum. — U.  S. — Liquefied 
Phenol,  Liquid  Carbolic  Acid,  contains  from  85  to 
89  per  cent,  of  absolute  phenol,  and  is  the  form 


LOCAL  ANTISEPTICS. 


39 


in  which  this  substance  is  usually  seen  and  used. 

Phenol  or  carbolic  acid  is  now  used  as  an  anti- 
septic dressing  for  wounds  very  much  less  fre- 
quently than  it  was  some  years  ago,  because  of  the 
danger  of  poison  due  to  absorption.  It  may  be 
applied  in  the  form  of  a 2 per  cent,  solution  in 
water ; stronger  solutions  are  used,  but  many  cases 
of  gangrene  have  followed  the  use  of  even  dilute 
solutions  on  the  extremities,  particularly  the 
hands,  for  a continued  length  of  time. 

A sharp  distinction  is  to  be  drawn  between  the 
anesthetic  and  antiseptic  uses  of  phenol.  Solu- 
tions of  phenol  in  oil,  or  mixtures  with  fats,  are 
excellent  anesthetics  when  brought  in  contact  witli 
painful  surfaces  or  wounds,  hut  they  possess  very 
little  antiseptic  action,  because  phenol  is  more  sol- 
uble in  fats  and  oils  than  in  -water  or  weak  saline 
solutions,  hence  it  does  not  leave  the  oil  to  pene- 
trate the  bodies  of  bacteria,  without  doing  which 
it  does  not  injure  them. 

Practically  the  same  holds  true  of  its  affinity  for 
alcohol,  and  it  is  for  this  reason  that  alcohol  is 
such  an  excellent  antidote  for  carbolic  acid,  exter- 
nally as  well  as  internally.  The  absorption  of 
phenol  is  followed  by  its  appearance  in  the  urine, 
which  usually  becomes  dark  greenish  or  nearlv 
black  in  color. 

Cresol. — IT.  S. — and  its  more  desirable  form : 

Liquor  Cresolis  Comi>ositus. — II.  S. — Com- 
pound Solution  of  Cresol  has  been  mentioned 
under  general  disinfectants.  The  latter  compound 
has  been  extensively  used,  particularly  in  the  form 
of  one  or  the  other  of  the  numerous  proprietary 
preparations,  as  a local  disinfectant  and  also  as  an 
antiseptic.  The  saponaceous  properties  of  this 


40 


PHARMACOPEIA  AND  PHYSICIAN. 


particular  preparation  make  it  very  useful  in  a 
variety  of  instances  in  -which  a detergent  action  is 
to  be  attained  in  addition  to  the  disinfection. 

Thymol. — U.  S. — This  is  a phenol  occurring  in 
the  volatile  oil  of  Thymus  vulgaris  and  in  some 
other  volatile  oils.  It  possesses  strong  antiseptic 
properties,  but  its  comparative  insolubility  in 
water,  1 in  1,100,  has  interfered  materially  with 
its  extended  use.  Thymol  iodid,  the  only  official 
combination  of  thymol,  has  been  referred  to  in  con- 
nection with  iodoform  substitutes. 

An  ideal  disinfectant,  or  antiseptic  dressing  for 
wounds,  should  act  strongly  on  the  living  proto- 
plasm, should  be  slowly  absorbed,  and  should  af- 
fect the  central  nervous  system  but  slightly  after 
absorption.  Phenol  has  the  disadvantage  of  being 
rapidly  absorbed  and  of  profoundly  affecting  the 
central  nervous  system.  Thymol,  being  but  slight- 
ly soluble  in  water,  but  volatile  at  ordinary  tem- 
peratures, is  slowly  absorbed,  and,  as  its  excretion 
keeps  pace  with  its  absorption,  there  is  little  dan- 
ger that  it  will  exert  a poisonous  action  when  used 
locally. 

Resorcinol. — U.  S. — Resorcinum  (U.  S.  P. 
1890),  a diatomic  phenol  that  is  usually  referred 
to  by  its  popular  name,  resorcin,  was  at  one  time 
extensively  used  in  dermatologic  practice,  but  is 
now  seldom  employed  except  for  scalp  diseases  and 
sometimes  internally. 

Pyrooallol. — U.  S. — This  is  better  known  as 
pyrogallic  acid  and  is  a triatomic  phenol,  some- 
times used  in  dermatologic  practice. 

Actdum  Salicylicum.— U.  S. — Salicylic  Acid 
has  been  used  to  some  extent  as  a local  antiseptic, 
particularly  in  the  form  of  dusting  powders,  di- 


LOCAL  ANTISEPTICS. 


41 


luted  with  talcum,  zinc  oxid  or  boric  acid.  Sali- 
cylic acid  is  used  extensively  in  dermatologic  prac- 
tice, particularly  in  the  form  of  ointment.  It  is 
only  slightly  soluble  (1/310)  in'water. 

The  practice  of  dermatology  involves  a special 
knowledge  of  antisepsis,  and  the  subject  can  be 
given  only  general  consideration  at  this  time,  so 
that  we  must  content  ourselves  with  little  more 
than  a simple  enumeration  of  some  of  the  official 
substances  that  are  used,  merely  suggesting  the 
number  and  variety  of  the  available  materials. 

Pix  Ltquida. — IT.  S.— Tar,  a product  obtained 
by  the  destructive  distillation  of  the  wood  of  one 
of  several  species  of  Finns,  has  been  widely  used 
in  the  treatment  of  skin  diseases,  usually  in  the 
form  of  an  ointment. 

Unguentum  Prcis  Liquids. — U.  S. — Tar 
Ointment  contains  50  per  cent,  of  tar. 

Oleum  Cadinum. — U.  S. — Oil  of  Cade,  or  oil 
of  juniper  tar,  is  a product  of  the  dry  distillation 
of  Juniperus  Oxycedrus  and  is  closely  allied  to 
tar,  being  used  in  the  same  way. 

Balsamum  - Peuuvianum. — IT.  S.- — Balsam  of 
Peru  will  be  referred  to  again  under  expectorants. 
Its  antiseptic  properties  are  probably  due  to  the 
benzoic  and  cinnamic  acids  which  it  contains.  It 
is  used  in  dermatology,  either  in  ointment  or  in 
collodion. 

Na  phthalenum  . — U.  S. — Naphthalene  or 

naphtalin  and 

B etaxapptthol. — IT.  S. — Naphtol,  are  used  in 
dermatologic  practice,  though  the  former,  at  least, 
has  practically  fallen  into  disuse  for  medicinal 
purposes. 


42 


PHARMACOPEIA  AND  PHYSICIAN. 


Among  other  substances  having  antiseptic  prop- 
erties, used  locally,  we  have: 

Sulphur  Precipitatum. — U.  S. — Precipitated 
Sulphur.  This  and  the  other  official  forms  of  sul- 
phur will  be  mentioned  in  connection  with  cathar- 
tics. Sulphur  constitutes  a most  important  agent 
in  the  treatment  of  a number  of  skin  diseases.  It 
is  applied  either  in  the  form  of  lotions  or  of  oint- 
ments. For  the  former,  precipitated  sulphur  is 
usually  preferred,  while  in  ointments  either 

Sulphur  Sublimatum. — U.  S. — Sublimed 

Sulphur,  or 

Sulphur  Lotum. — U.  S. — Washed  Sulphur  is 
used.  In  the  official 

Unguentum  Sulphuris. — U.  S. — Sulphur 

Ointment,  15  per  cent,  of  washed  sulphur  is  di- 
rected to  be  used.  This  ointment  is  now  only  half 
the  strength  of  that  formerly  official  and  is,  there- 
fore. better  suited  as  a mildly  stimulating  anti- 
septic application. 

Sodii  Ttiiosulphas. — U.  S. — Sodium  Thiosul- 
phate, better  known  as  sodium  hyposulphite,  is 
another  useful  antiseptic  that  is  now  little  used 
medicinally,  except  in  dermatology.  It  is  freely 
soluble  in  water  and  is  usually  prescribed  in  the 
form  of  a lotion.  It  is  said  to  be  particularly  use- 
ful in  the  destruction  of  parasitic  fungi  which  in- 
fest the  skin. 

Glycertkum. — U.  S. — Gtycerin  is  not  alone 
useful  as  a mild  antiseptic,  but  is  also  extensively 
used  as  a vehicle  for  many  other  substances  in  the 
treatment  of  skin  lesions. 

Glyceritum  Amyli. — U.  S. — Glycerite  of 
starch  is  a preparation  that  was  introduced  many 


LOCAL  ANTISEPTICS. 


43 


years  ago  to  serve  as  an  ointment  base  in  cases  in 
which  lard  or  fat  might  prove  objectionable. 

MERCURIALS. 

Hydrargyri  Iodidum  Rubrum. — U.  S. — Red 
Mercuric  Todid  or  biniodid  of  mercury  is  the  most 
active  of  all  the  official  germicides  and  antiseptics. 
It  is  comparatively  expensive,  however,  and  is  only 
slightly  soluble  in  water. 

Hydrargri  Chloridum  Corrosivum. — U.  S. — 
Corrosive  Mercuric  Chlorid,  bichlorid  of  mercury, 
mercuric  chlorid,  or,  more  properly,  corrosive 
sublimate,  is  by  far  the  most  popular  and  most 
generally  used  of  all  local  chemical  disinfectants 
and  antiseptics.  It  is  extremely  poisonous  and 
many  fatalities  have  occurred  from  its  use,  even 
in  the  vagina  and  in  the  washing  of  wounds. 
Gauze  impregnated  with  a solution  of  mercuric 
chlorid  is  often  placed  over  small  or  closed  wounds 
to  prevent  the  access  of  bacteria.  It  is  widely 
used  as  an  antiseptic  and  disinfectant,  but  it  is 
extremely  caustic  and  can  not  be  applied  to  mu- 
cous membranes  and  to  open  wounds  except  in 
very  dilute  solutions,  for  fear  of  absorption. 

Mercuric  chlorid  is  slowly  but  completely  solu- 
ble in  13  parts  of  water  and  in  3 parts  of  alcohol. 
The  solubility  of  this  substance  in  water  is  much 
facilitated  by  the  presence  of  other  soluble  chlorids. 
This  fact  has  been  utilized  in  the  preparation  of 
the  commercial  tablets  of  mercuric  chlorid  that 
are  sold  for  making  antiseptic  solutions.  These 
tablets  usually  contain  about  0.5  gm.  (7.5  grains) 
each  of  mercuric  chloric!  and  ammonium  chlorid, 
the  sal  alembroth  of  the  alchemists,  which,  when 
dissolved  in  500  c.c.  (1  pint)  of  water  make  a solu- 


44 


PHARMACOPEIA  AND  PHYSICIAN. 


tion  of  1 to  1,000.  This  solution  is  useful  for  the 
disinfection  of  the  hands,  for  walls  and  floors  and 
for  man}''  fabrics  that  are  not  injured  by  water. 

Mercuric  chlorid  attacks  metals  and,  therefore, 
must  be  avoided  with  metal  instruments.  It  is 
a very  popular  insecticide  and  a number  of  the 
mercurials  are  used  as  parasiticides,  notably  for 
pediculi.  For  this  purpose,  however,  the  various 
ointments  of  mercury  are  preferable. 

Unguentum  Hydrargyri. — TJ.  S. — Mercurial 
Ointment,  contains  50  per  cent,  of  mercury. 

Unguentum  Hydrargyri  Dilutum. — U.  S. — 
Blue  Ointment,  a new  addition  to  the  Pharmaco- 
peia, contains  33  per  cent,  of  mercury  and  con- 
forms more  closely  to  the  proposed  international 
standard  for  mercurial  ointment.  Another  oint- 
ment that  is  sometimes  used  as  a parasiticide  is 

Unguentum  Hydrargyri  Oyidi  Rubri. — U.  S. 
— Ointment  of  Red  Mercuric  Oxid,  or  red  precipi- 
tate ointment,  containing  10  per  cent,  of  red  mer- 
curic oxid. 

ANTISEPSIS  OF  THE  MUCOUS  MEMBRANES. 

The  antisepsis  of  the  mouth  is  important,  not 
only  because  of  the  infectious  diseases  pertaining 
to  it,  but  also  because  of  the  excellent  opportunity 
that  is  afforded  to  micro-organisms  to  multiply 
there  in  enormous  numbers  on  the  particles  of 
food  in  the  cavities  of  teeth  or  wedged  between 
them.  That  this  is  true  is  shown  by  the  putrid 
smell  acquired  by  particles  of  meat  which  remain 
but  an  hour  or  so  in  the  mouth.  The  extent  to 
which  bacteria  may  increase  may  be  inferred  from 
tbe  calculation,  given  by  ISTovv,  that  30,000,000.- 


LOCAL  ANTISEPTICS. 


45 


000  contain  less  than  one-sixth  of  a milligram 
(1/400  grain)  of  organic  matter. 

The  main  factor  in  securing  antisepsis  of  the 
mouth  is  cleanliness.  If  the  teeth  are  carefully 
cleansed  and  all  organic  matter  removed,  the  bac- 
teria have  less  on  which  to  thrive,  and  mild  anti- 
septics then  fully  suffice  to  keep  the  number  with- 
in bounds. 

Liquor  Antisepticus.— " IT.  S. — Antiseptic  So- 
lution is  a new  addition  to  the  Pharmacopeia,  con- 
taining 2 per  cent,  of  boric  acid  with  aromatic  an- 
tiseptic volatile  oils.  It  is  designed  to  be  used  as  a 
mild  antiseptic  lotion  or  wash.2 

The  official  antiseptic  solution  is  also  useful  as  a 
gargle,  preferably  diluted  with  an  equal  quantity 
of  water.  The  use  of  hydrogen  dioxid  as  a spray 
or  gargle,  as  well  as  its  use  in  connection  with  the 
official  antiseptic  solution,  has  been  mentioned. 

Potassii  Chloras. — IT.  S. — Potassium  Chlor- 
ate, while  not  a particularly  active  antiseptic,  has 


2.  The  official  antiseptic  solution  is  slightly  acid.  When 
an  alkaline  antiseptic  mouth  wash  is  desired  it  will  be  well 
to  use  the  “Alkaline  Antiseptic  Solution’’  of  the  National 
Formulary.  Either  one  of  these  preparations  can  readily 
be  prepared  by  any  trained  pharmacist.  They  are  very 
inexpensive  and  should  be  given  the'  preference  over  the 
various  nostrums  that  are  not  alone  exploited  as  local  anti- 
septics, but  are  also  advertised  as  sure  cure  remedies  for 
a very  large  number  of  intestinal  disorders.  The  working 
formula  for  the  alkaline  antiseptic  solution  is  as  follows  : 


Fotassium  bicarbonate 

Sodium  benzoate,  fin 

3 i 

32 

Borax  

oil 

8 

Thvmol  

. . . grs.  iii 

Eucal.vptol, 

Oil  of  peppermint,  aa 

m.  iii 

Oil  of  wintergreen 

m vi 

Tincture  of  cudbear  

3iv 

15 

Alcohol  

SH 

60 

Glycerin  

Jvui 

250 

Water,  sufficient  to  make.  . . 

. . . .Sxxxiv 

1000 

46 


PHARMACOPEIA  AND  PHYSICIAN. 


long  been  favorably  known  to  be  a desirable  addi- 
tion to  gargles  and  mouth  washes.  It  is  soluble 
in  16  parts  of  cold  water  and  is  generally  used  in 
saturated  solution,  from  which  traces  of  chloric 
acid  may  possibly  be  liberated.  Alum  and  boric 
acid  are  also  useful  as  gargles. 

After  the  use  of  any  of  these  gargles  the  mouth 
should  be  well  rinsed  with  water  to  prevent  injury 
to  the  teeth. 

The  antisepsis  of  the  nasal  passages  is  usually 
accomplished  by  thorough  cleansing  wTith  warm  sa- 
line solution  (0.9  per  cent.),  nine  grams  (135 
grains)  to  a liter  (quart)  of  water,  or  by  a mild 
alkaline  solution  made  by  adding  nine  grams  (135 
grains)  of  sodium  bicarbonate  to  the  saline  solu- 
tion just  mentioned,  after  which  a mildly  antisep- 
tic solution,  such  as  the  official,  is  used  as  a spray 
or  douche,  or,  in  lieu  of  this,  one-tenth  of  1 per 
cent,  of  phenol  may  be  added  to  the  saline  douche, 
but  the  latter  is  not  recommended  as  a routine 
practice.3 

It  may  be  permissible  here  to  enumerate  some 
of  the  substances  that  have  been  or  are  used  as 
mild  antiseptic  applications  to  the  mucous  mem- 
branes. 

Acidum  Bokicuh. — U.  S. — Boric  Acid,  gen- 
erally referred  to  as  boracie  acid,  is  quite  free 


3.  The  pharmacopeia  of  the  German  Hospital,  Philadel- 
phia, contains  a formula  for  an  alkaline  antiseptic  tablet 
that  has  found  favor  with  some.  It  contains  0.25  gm. 
(about  4 grains)  each  of  sodium  bicarbonate,  sodium  borate, 
sodium  chlorid  and  sodium  phenosulphate,  with  0.005  gm. 
(about  0.1  minim)  of  oil  of  cinnamon.  One  of  these  tablets 
(the  same'  mixture  can  also  be  directed  in  powder)  is  to  be 
dissolved  in  six  tablespoonfuls  of  recently  boiled  water  and 
used  as  a wash  for  the  nose. 


LOCAL  ANTISEPTICS. 


47 


from  toxicity.  It  is  soluble  in  about  16  parts  of 
water  and  is  but  slowly  absorbed. 

Glyceritum  Boroglycerini.— U.  S. — Glvcer- 
ite  of  Boroglycerin,  contains  30  per  cent,  of  boric 
acid  and  has  the  same  uses  as  that  acid. 

Sodii  Boras. — U.  S. — Sodium  Borate,  or  borax, 
has  an  alkaline  reaction  and  is  sometimes  preferred 
to  boric  acid  on  this  account.  It  is  soluble  in  six- 
teeen  parts  of  water. 

Somi  Chi.oridum. — U.  S. — Sodium  Clilorid, 
common  table  salt,  has  been  in  use  as  an  antiseptic 
from  time  immemorial,  and  the  only  reason  we 
have  for  presenting  it  here  is  to  call  attention  to 
the  fact  that  the  Pharmacopeia  recognizes  it  as  a 
valuable  article  of  the  materia  medica  and  pro- 
vides certain  standards  and  tests  for  purity. 

Sodii  Piienolsulphonas. — U.  S. — Sodium 

Phenol sulphonate,  the  sodium  sulphocarbolate  of 
former  editions  of  the  Pharmacopeia,  is  another 
mild  antiseptic  that  has  limited  but  well-defined 
uses. 

Practically  all  the  salts  of  the  alkalies  have  anti- 
septic properties,  but  it  is  obviously  not  necessary 
to  recount  all  of  them  at  this  time. 

Complete  disinfection  of  the  nose,  mouth,  throat, 
vagina  and  urethra  is  not  practicable,  and  is  not 
even  necessary ; the  main  thing  to  be  sought  is  the 
cleansing  of  those  regions  from  pus  and  organic 
matter  on  which  bacteria  thrive.  Mucous  mem- 
branes decompose  the  solution  of  hydrogen  dioxid 
with  such  copious  evolution  of  oxygen  that  it  can 
not  be  used  in  the  nose,  and  because  of  this  rapid 
action  by  the  mucous  membrane  itself,  a large 
amount  frequently  repeated  is  necessary  to  com- 
pletely disinfect  such  cavities.4 


48 


PHARMACOPEIA  AND  PHYSICIAN. 


The  antisepsis  of  the  eye  is  confined  largely  to 
the  use  of  camphor  water,  boric  acid  and  sodium 
borate.  In  virulent  affections  more  active  antisep- 
tics are  sometimes  indicated;  in  these  cases  weak 
solutions  of  mercuric  chlorid,  copper  sulphate,  zinc 
cblorid,  silver  nitrate  or  formaldehyd  are  used. 
These  substances,  however,  are  all  extremely  irri- 
tating and  great  caution  is  required.  Their  use 
by  the  general  practitioner  is  not  advised.4 5 

Some  years  ago  J.  Stilling  recommended  the  use 
of  the  anilin  colors,  more  especially  pyoktannin 
blue  and  pyoktannin  yellow,  as  weakly  antiseptic 
applications  to  the  eye.  Pyoktannin  yellow  is  still 
used  to  some  extent  either  as  powder,  pencil  or  in 
watery  solution. 

Burns  or  scalds  resulting  in  destruction  of  the 
skin  should  be  treated  antiseptically.  Treves  di- 
rects that  the  burn  be  washed  with  a solution  of 


4.  For  use  in  the  vagina,  where  a simple  detergent  and 
antiseptic  action  is  sought,  the  official  Liquor  Cresolis  Com- 
positus  in  0.5  to  1 per  cent,  solution  will  be  found  to  be  all 
that  is  required.  When  an  astringent  effect  is  desired  the 
following  formula  for  an  antiseptic  astringent  powder  will  be 
found  to  answer  the  purpose  very  well : 


R.  Sodi  boratis  Sil  60 

Alumen  exsicc  3x  40 

Thymol, 

Phenol, 


A llCU  Ul, 

Eucalyptol 

Olei  gautheri®,  aa gr.  vlil  5 

M.  Sig.  : A heaping  teaspoonful  to  be  dissolved  in  one 

liter  (1  quart)  of  hot  water,  to  be  used  as  a douche. 

5.  The  method  of  using  boric  acid  in  the  eye  varies 
greatly,  but  usually  a 2 per  cent,  solution  of  boric  acid  in 
equal  parts  of  distilled  water  and  camphor  water  will  be 
found  to  be  sufficient.  When  it  is  desired  to  use  sodium 
borate  in  connection  with  boric  acid  the  following  will  be 
found  satisfactory : 

JJ.  Acldi  boric!  gr.  xv  1. 

Sodii  boratis  gr.  xxx  2 

Aqu®  dest., 

Aqu®  camphor®,  aa XIss  50 


LOCAL  ANTISEPTICS. 


49 


hydrogen  dioxid  and  then  with  a solution  of  boric 
acid ; the  vesicles  are  then  opened  with  an  aseptic 
needle  and  the  surface  dusted  with  iodoform  and 
dressed  with  aseptic  cotton. 

Linimentum  Calcis. — U.  S. — Lime  Liniment, 
or  Carron  oil,  so  called  from  the  name  of  the  iron 
works  in  England  where  this  preparation  had  its 
origin,  consists  of  equal  parts  of  lime  water  and 
linseed  oil.  It  has  long  been  in  use  as  a popular 
dressing  for  superficial  burns  and  constitutes  a 
readily  applied  and  effective  non-antiseptic  remedy 
that  rapidly  allays  the  accompanying  pain.  If 
there  has  been  extensive  destruction  of  tissue,  this 
remedy  should  be  avoided,  as  it  is  not  alone  diffi- 
cult to  remove,  but  also  forms  a covering  beneath 
which  bacteria  may  proliferate  safe  from  the  reach 
of  antiseptics. 

Potassii  Permaistganas. — U.  S. — Potassium 
Permanganate,  already  referred  to  under  the  head 
of  general  disinfectants,  is  often  considered  to  be 
devoid  of  antiseptic  properties  because  of  the  readi- 
ness with  which  it  oxidizes  all  organic  matter.  It 
is  true  that  potassium  permanganate  is  readily  de- 
composed by  the  organic  matter  with  which  it  first 
comes  in  contact,  and  that  it  would  be  unusual  in- 
deed to  find  bacteria  the  only  form  of  organic  mat- 
ter present  in  any  one  case.  When  we  remember, 
however,  that  a very  large  number  of  bacteria 
represent  but  an  infinitesimally  small  amount  of 
organic  matter,  we  will  appreciate  why  potassium 
permanganate  is  capable  of  destroying  vast  num- 
bers of  micro-organisms  in  those  cases  in  which 
its  action  can  be  confined  to  them. 

This  substance  finds  its  greatest  usefulness  as  a 
local  application  in  rendering  foul  ulcers  odorless. 


50 


PHARMACOPEIA  AND  PHYSICIAN. 


For  this  purpose  a fairly  strong  solution,  2 per 
cent.,  is  freely  used  as  a wash.  Much  weaker  solu- 
tions are  sometimes  used  with  great  benefit  as 
urethral  irrigations  in  gonorrhea  and  as  vaginal 
douches.  A hot  1 per  cent,  solution  of  potassium 
permanganate  will  be  found  extremely  useful  as  a 
deodorizer  for  instruments  after  use  in  the  vagina 
while  awaiting  sterilization.  Potassium  perman- 
ganate destroys  some  alkaloids  much  more  quickly 
than  others,  e.  g.,  morphin  more  readily  than 
strychnin.  It  can  not  enter  the  circulation,  hence, 
when  swallowed,  it  can  act  only  on  the  substances 
found  in  the  stomach.  Obviously  it  is  not  suited 
for  hypodermic  injections. 


CHAPTER  III. 


INTERNAL  ANTISEPTICS. 

The  great  strides  made  in  the  use  of  antisep- 
tics, after  Lister  had  employed  them  in  surgery 
with  such  brilliant  results,  led  to  the  hope  that 
they  might  be  made  available  for  limiting  the  de- 
velopment of  bacteria  in  various  parts  of  the  hu- 
man bodjr.  Erom  time  to  time  clinicians  have  re- 
ported favorable  results  from  the  use  of  internal 
antiseptics  in  such  diseases  as  typhoid  fever,  but 
at  the  present  time  it  is  generally  acknowledged 
that  complete  disinfection  of  the  intestinal  tract  is 
impossible  and  that  the  treatment  of  constitutional 
diseases  by  means  of  antiseptics  is  possible  only  in 
a few  isolated  cases;  for  example,  in  malarial 
fever  by  quinin,  in  articular  rheumatism  by  sali- 
cylic acid  and  its  compounds,  and  in  syphilis  bv 
means  of  mercurials.  Quinin  has  been  shown  to 
have  a peculiarly  selective  and  destructive  action 
on  the  protozoon  which  causes  malarial  fever,  and 
perhaps  mercury  and  salicylic  acid  may  possess 
similar  selective  action  against  the  agents  produc- 
ing syphilis  and  certain  forms  of  rheumatism.  It 
is  no  longer  considered  probable  that  there  will  be 
found  any  agent  or  group  of  agents  capable  of 
rendering  the  blood  and  tissues  sterile  to  all  or  to 
any  considerable  number  of  bacteria;  but  it  is  ad- 
mitted that  we  may  yet  find  many  agents,  each  ex- 
erting an  influence  analogous  to  that  of  quinin  in 
malarial  fever;  we  may  limit  ourselves,  therefore, 
to  the  discussion  of  the  probable  action  of  antisep- 


52 


PHARMACOPEIA  AND  PHYSICIAN. 


tics  on  the  alimentary  canal  and  of  the  three  sub- 
stances just  enumerated. 

It  is  impossible  to  form  a correct  idea  of  the 
probable  effect  of  an  internal  antiseptic  without 
having  at  least  some  idea  of  the  organisms  on 
which  it  must  act. 

Nuttall  and  Thierf elder  took  guinea-pigs  from 
their  mother  by  Cesarean  section  under  aseptic 
conditions,  and  fed  one  of  them  on  sterilized  food 
for  thirteen  days,  during  which  it  continued  to 
strive,  but  Schotelius  found  that  chickens  died  of 
starvation  when  fed  only  on  sterilized  food.  G. 
1ST.  Stewart  accepts  Nuttall  and  Thierf  elder’s  re- 
sults as  demonstrating  that  animals,  including 
man,  exist,  despite  the  bacteria  which  infest  the 
alimentary  canal  from  a few  hours  after  birth  until 
death. 

Strassburger  concludes,  from  a review  of  the 
extensive  literature  pertaining  to  intestinal  bac- 
teria, that  Nuttall  and  Thierfelder  have  shown  that 
no  single  process  of  alimentation  is  absolutely  de- 
pendent on  bacteria,  but  that  the  chief  function  of 
certain  of  them,  notably  the  colon  bacillus,  which 
is  always  abundantly  present,  is  actually  to  destroy 
other  bacteria  and  thus  to  protect  the  host  against 
those  disease  germs  which  may  gain  entrance  to 
the  alimentary  canal.  The  destruction  of  all  the 
bacteria  in  the  alimentary  canal  at  any  one  time, 
therefore,  might  prove  fatal,  in  that  any  disease 
germs  which  chanced  to  gain  access  to  the  intestine 
could  so  multiply  as  quickly  to  destroy  the  life  of 
the  host. 

The  proof  that  bacteria  do  play  some  part  in  the 
process  of  digestion  is  found  in  the  fact  that  man 
can  digest  the  cellulose  of  delicate  vegetables  to  a 


INTERNAL  ANTISEPTICS. 


53 


limited  extent,  though  he  secretes  no  enzyme  cap- 
able of  splitting  cellulose,  which,  therefore,  must 
be  split  by  bacteria  present  which  have  been  shown 
to  possess  that  power.  Then,  too,  certain  crystal- 
line bodies  other  than  leucin  and  tyrosin  have  re- 
cently been  found  among  the  ultimate  products  of 
digestion,  and  as  none  of  the  known  digestive 
enzymes  are  capable  of  forming  these  bodies  they 
likewise  must  result  from  bacterial  action. 

While  we  must  admit  that  bacteria  are  concerned 
in  digestion,  we  have  no  positive  information  at  the 
present  time  as  to  how  important  a part  they  ac- 
tually take.  It  has  been  shown  that  the  colon  ba- 
cillus, which  is  universally  present  in  milk,  inhib- 
its, to  a certain  extent,  the  action  of  putrefactive 
bacteria,  and  it  is  well  known  that  untreated  milk 
of  good  quality  is  more  digestible  than  is  the  same 
milk  after  sterilization.1 

We  are  thus  forced,  by  this  and  other  like  evi- 
dence, to  conclude  that  it  is  by  no  means  desirable 
to  render  the  intestines  sterile  and  that,  instead  of 

1.  Tests  made  on  the  several  constituents  of  milk  show 
that  they  have  no  power  to  inhibit  putrefaction,  though, 
such  a power  is  unquestionably  possessed  by  fresh  milk. 
That  this  is  due,  at  least  in  part,  to  certain  bacteria  nor- 
mally present  in  the  milk  is  shown  by  the  fact  that  sterilized' 
milk  putrefies  much  more  rapidly  than  untreated  milk  on 
the  addition  of  the  bacillus  of  putrefaction  ( B . putriflcus)  ; 
but  if  with  the  Bacillus  putriflcus  the  colon  bacillus  be 
added  to  sterilized  milk,  the  milk  acts  as  does  normal  milk, 
thus  proving  that  the  colon  bacillus  is  actually  capable  of 
inhibiting  the  development  of  certain  bacteria.  It  is,  of 
course,  possible  that  fresh  milk  also  possesses  antibacterial 
properties  which  are  destroyed  by  the  sterilization.  These 
conditions  help  to  explain  why  sterilized  milk  is  not  so 
wholesome  as  new  milk  of  good  quality.  It  must  be  remem- 
bered, however,  that  milk  is  an  excellent  culture  medium  in 
which  a great  many  bacteria  are  normally  present,  and  that 
if  it  be  allowed  to  stand  in  a warm  place  for  some  hours 


54 


PHARMACOPEIA  AND  PHYfHCIAX. 


attempting  intestinal  antisepsis  in  the  broader 
sense,  we  should  seek  rather  to  modify  the  flora  in 
that  region  than  to  destroy  it. 

Various  .methods  have  been  proposed,  from  time 
to  time,  for  determining  the  relative  degree  of 
putrefaction  taking  place  in  the  intestines,  but  at 
the  present  time  it  is  not  positively  known  what 
constitutes  the  best  method  at  bur  disposal  for 
doing  this.  The  procedure  most  frequently  em- 
ployed, one  which  is  considered  to  afford  a fair  es- 
timate in  a large  proportion  of  cases,  consists  in  es- 
timating the  ethereal  sulphates  in  the  urine.  Strass- 
iburger  claims  that  weighing  the  bacteria  after  sep- 
aration from  the  feces  and  drying  affords  the  surest 
means  of  estimating  the  number  of  bacteria  pres- 
ent. Others  count  the  number  of  colonies  which 
can  be  cultivated  from  a milligram  of  feces,  but 
this  has  been  shown  to  be  unreliable.  In  view  of 
the  fact  that  laboratory  methods  are  far  from  satis- 
factory in  determining  the  number  of  the  several 
varieties  of  bacteria  present  in  the  feces,  the  gen- 
eral practitioner  will  probably  be  obliged,  for  some 


the  micro-organisms  multiply  to  such  an  extent  that  the 
milk  is  wholly  unfit  for  use,  and  we  do  not  wish  to  be  mis- 
understood as  implying  that  the  colon  bacillus  is  afi  un- 
mixed blessing.  While,  during  health,  the  micro-organism 
probably  does  not  emigrate  from  the  uninjured  intestine  it 
may  do  so  in  states  of  lowered  general  resistance,  or  in  the 
presence  of  defects  of  the  intestinal  epithelium,  and  may  give 
rise  to  blood  infection,  or  more  rarely  to  inflammations  in 
various  organs.  The  possibility  that  the  bacillus  of  typhoid 
fever  and  kindred  forms  are  only  modified  colon  bacilli  is 
of  theoretical  importance.  Some  authorities  (Escherich  and 
some  others)  deny  that  the  colon  bacillus  is  capable  of  rap- 
idly becoming  virulent.  Different  strains  of  the  colon  bacil- 
lus have  different  degrees  of  virulence,  and  it  still  remains 
possible  that  many  cases  of  infantile'  colitis  are  caused  by 
certain  strains  (e.  g.,  the  colicolitis  of  Escherich). 


1 N Tli  Ills  A L A N TISEPTICS. 


55 


time  to  come,  to  depend  largely,  if  not  entirely,  on 
the  clinical  data  presented  by  each  individual  case. 

Without  knowing  the  precise  role  played  by  the 
multitudinous  bacteria  of  many  species,  we  do 
know  in  various  ways  when  undue  activity  of  .the 
putrefactive  bacteria  occurs  and  certain  symptoms 
give  notice  that  excessive  fermentation  is  taking 
place  in  the  small  intestine.  A moderate  increase 
in  the  number  of  colon  bacilli  tends  to  lessen  the 
development  of  the  putrefactive  germs;  on  the 
other  hand,  an  intestinal  catarrh,  caused  by  exces- 
sive acidity  resulting  from  the  undue  fermenta- 
tion of  carbohydrates  by  the  colon  bacillus,  may  be 
alleviated  by  lessening  the  carbohydrates  of  the 
food  and  consequently  the  medium  on  which  the 
colon  bacillus  thrives. 

Normal  peristalsis,  by  hurrying  the  food  through 
the  small  intestine,  prevents  undue  development 
of  bacteria,  but  diarrhea  and  irritant  purgatives 
favor  the  development  of  bacteria  by  the  increased 
amount  of  liquid  which  is  present,  because  of  the 
increased  secretion  of  diminished  absorption.  Thus 
more  bacteria  have  been  found  after  administra- 
tion of  calomel  than  were  present  before  the  drug 
had  been  given,  though  calomel  is  generally  con- 
sidered to  be  an  excellent  antiseptic. 

While  normal  peristalsis  limits  the  develop- 
ment of  bacteria,  the  latter,  in  turn,  liberate  acids 
in  the  decomposition  of  carbohydrates  which  prob- 
ably supply  the  stimulus  which  sets  up  peristalsis. 
The  normal  digestion  and  absorption  of  food  also 
tend  to  lessen  intestinal  putrefaction  by  lessening 
the  amount  of  material  which  can  serve  as  a cul- 
ture medium. 

It  is  important  that  the  intestinal  wall  should 


56 


PHARMACOPEIA  AND  PHYSICIAN. 


be  kept  intact.  When  the  intestinal  mucosa  is  in- 
jured it  fails  to  absorb  the  food  products  and  the 
bacteria  multiply  rapidly.  It  has  been  found  that 
many  antiseptics  injure  the  intestinal  wall  more 
than  they  do  the  bacteria,  and,  despite  the  fact  that 
the  antiseptic  may  be  found  in  quantity  in  the 
feces  when  the  bulk  is  small,  it  has  actually  permit- 
ted an  increased  growth  of  micro-organisms  in  the 
small  intestine  when  other  conditions  favored  the 
bacteria  and  not  the  antiseptic  action.  Strass- 
burger  found  just  double  the  number  of  bacteria 
after  the  use  of  naphthalene,  which  has  been  con- 
siderably lauded  as  an  intestinal  antiseptic. 

As  suggested  before,  the  simplest  means  of  di- 
minishing the  number  of  putrefactive  bacteria  is 
by  lessening  the  amount  of  the  proteid  of  the  food. 
Though  it  has  been  contradicted  by  the  indirect 
evidence  of  urinary  constituents,  it  has  been  shown 
that  the  bacteria  of  the  intestines  are  very  much 
reduced  in  number  by  the  withdrawal  of  all  food. 

It  was  formerly  supposed  that  the  gastric  juice 
of  the  stomach  interposed  a fairly  effective  barrier 
to  the  entrance  of  living  disease  germs  into  the  in- 
testine. but  this  juice  has  but  little  effect  at  the  be- 
ginning of  digestion,  when  the  activity  is  slight, 
and  toward  the  end,  when  the  hydrochloric  acid  is 
nearly  all  combined  with  proteid.  Some  micro- 
organisms, e.  g.,  the  tubercle  bacillus,  pass  unin- 
jured through  the  stomach  more  readily  than  oth- 
ers, e.  g.,  the  vibrio  of  cholera. 

The  effect  of  bile  on  bacteria  is  not  positively 
known,  but  it  is  generally  supposed  that  it  does  not 
contain  any  germicidal  power,  as  some  bacteria'can 
be  cultivated  on  bile,  though  not  after  the  precipi- 
tation and  removal  of  the  mucus.  The  intestinal 


INTERNAL  ANTISEPTICS. 


57 


secretion  does  not  possess  any  germicidal  power. 
All  these  factors  are  important,  since  all  of  them — 
bile,  gastric  juice  and  intestinal  secretion — have  at 
various  times  been  supposed  to  possess  antiseptic 
properties,  and  it  is  necessary  to  know  what  results 
are  to  be  expected  from  increasing  the  quantity  of 
any  or  all  of  them. 

Strictly  speaking,  the  antisepsis  of  the  alimen- 
tary canal  should  begin  with  that  of  the  mouth,  but 
this  is  more  conveniently  considered  under  local 
antisepsis.  In  view  of  the  fact  that  the  gastric 
juice  does  not  interpose  an  absolute  barrier  to  the 
ingress  of  pathogenic  bacteria  to  the  intestine,  the 
proper  care  of  the  mouth  and  the  limitation  of  its 
flora  assumes  an  added  importance,  and  there  is  no 
question  of  the  fact  that  proper  attention  to  the 
cleanliness  of  the  oral  cavity  will  greatly  lessen  the 
danger  from  intestinal  infection. 

The  general  tone  of  these  varied  statements  may 
appear  pessimistic,  so  far  as  faith  in  the  efficiency 
of  intestinal  antisepsis  is  concerned,  but  so  far 
from  that  being  the  case  they  are  intended  to  fur- 
ther demonstrate  that  our  main  reliance  must,  after 
all,  be  placed  in  guarding  against  the  entry  of 
disease-producing  organisms  into  the  alimentary 
canal  and  their  destruction  before  they  have  passed 
beyond  the  reach  of  local  treatment.  After  they 
have  once  gained  admittance  to  the  intestine  the 
best  means  of  limiting  their  development  must  be 
sought  in  regulating  the  diet  and  careful  attention 
to  the  general  condition. 

If  we  are  unable  to  destroy  all  or  even  any 
appreciable  number  of  the  bacteria  of  the  intestine, 
it  is  consoling  to  know  that  some  of  them  are  our 
allies  instead  of  our  foes.  It  is  admitted  by  nearly 


58 


PHARMACOPEIA  AND  PHYSICIAN. 


all  authorities  that  it  is  impossible  to  influence  the 
bacillus  of  typhoid  fever  by  antiseptics.  It  has 
been  shown  that  a milk  diet  hinders  the  develop- 
ment of  putrefactive  bacteria,  and  many  consider 
that  the  main  benefit  derived  from  a milk  diet  in 
typhoid  fever  is  due  to  its  effect  on  bacterial  devel- 
opment. Fortunately,  the  Bacillus  typhosus  does 
not  form  spores  and  the  bacillus  itself  is  easily 
killed  outside  of  the  bod}r;  heating  in  water  even 
to  75  C.  (1G7  F.)  for  ten  minutes  greatly  lessens 
its  vitality. 

It  is  practically  impossible  in  the  space  at  our 
disposal  even  to  summarize  the  results  of  the  hun- 
dreds of  investigations  dealing  with  the  question  of 
intestinal  antisepsis.  Those  experiments  which  ap- 
pear more  nearly  free  from  error  point  to  the  fact 
that  we  can  not  secure  direct  antiseptic  action  by 
chemical  antiseptics  in  the  intestine  without  injur- 
ing the  intestinal  wall,  or  at  least  materially  reduc- 
ing those  conditions  which  naturally  limit  bacter- 
ial development,  more  than  we  injure  the  bacteria. 
The  net  result,  therefore,  is  usually  an  actual  in- 
crease of  some  species  and  a dimunition  of  others. 
Clinical  experience  seems  to  prove  conclusively  that 
the  mild  mercurous  chlorid,  or  calomel,  is  bene- 
ficial in  those  cases  of  indigestion  which  are  char- 
acterized by  that  train  of  symptoms  which  includes 
a feeling  of  dullness,  lassitude,  headache,  nausea 
and  anorexia,  the  condition  being  popirlarlv  termed 
“biliousness:”  It  is  possible  that  the  antiseptic  ac- 
tion of  the  calomel,  by  limiting  the  development  of 
other  species  of  bacteria,  gives  the  colon  bacillus 
a chance  to  multiply,  the  increased  amount  of  fluid 
in  the  intestine  having  been  found  particularly  to 
favor  its  development.  These,  in  turn,  may  then 


INTERNAL  ANTISEPTICS. 


59 


modify  digestion  or  serve  to  restrict  the  develop- 
ment of  putrefactive  bacteria,  and,  as  we  have  seen, 
they  favorably  influence  peristalsis,  which  in  turn 
is  one  of  the  natural  means  of  elimination  of  bac- 
teria. The  increased  peristalsis  caused  by  the  cal- 
omel lessens  the  opportunity  for  absorption  of  the 
bacterial  toxins  which  give  rise  to  the  train  of 
symptoms  mentioned ; this  lessened  absorption  may 
be  due  in  part  to  the  action  of  calomel  on  the  wall 
of  the  intestine.  This  merely  suggests  the  many- 
sidedness  of  an  operation  that  appears  at  first 
glance  to  be  a very  simple  one.  The  action  of  the 
solution  of  hydrogen  dioxid  in  the  mouth  and 
throat  has  been  discussed  under  local  antiseptics. 
Owing  to  the  rapidity  with  which  it  is  decomposed 
by  mucous  membranes  it  can  exert  but  little  germ- 
icidal action  in  the  stomach  and  absolutely  none  in 
the  intestine  or  general  circulation ; indeed^  it  is  so 
rapidly  decomposed  by  the  blood  that  it  speedily 
causes  death  by  embolism  when  introdced  into  the 
circulation.  The  same  holds  true  of  potassium  per- 
manganate. and  it  is  probable  that  all  antiseptics 
that  depend  for  their  action  on  the  liberation  of 
oxygen  would  be  decomposed  in  the  same  way  when 
brought  in  contact  with  the  mucous  membranes  of 
the  mouth  and  throat  or  the  organic  material  neces- 
sarily present  in  the  stomach. 

Acidum  Hydrociilortcum.— U.  S. — Hydro- 
chloric Acid,  or  muriatic  acid,  contains  31.9  per 
cent,  of  absolute  hydrochloric  acid.  It  is  seldom 
used  in  medicine  in  this  country,  the  preference 
being  usually  given  to 

Acidum  Hydrocttloricum  Dilutum. — IT.  S. — 
Diluted  Hydrochloric  Acid,  containing  10  per  cent, 
of  absolute  hydrochloric  acid.  This  acid  undoubt- 


60 


PHARMACOPEIA  AND  PHYSICIAN. 


edly  exerts  some  germicidal  action  in  the  stomach 
when  present  in  sufficient  amount,  and  its  action 
may  directly  influence  the  intestinal  flora.  It  has 
been  stated  that  the  hydrochloric  acid  of  the  stom- 
ach becomes  bound  to  albumin  during  digestion 
and  then  exerts  no  antiseptic  influence,  but  we 
have  also  seen  that  normal  digestion  is  one  of  the 
surest  means  of  controlling  the  bacteria  of  the  in- 
testine, and  how  a deficiency  of  that  acid  may  cause 
fermentative  dyspepsia,  with  an  enormous  increase 
of  bacteria,  which  may  become  virulent.  It  may 
be  mentioned  in  this  connection  that,  according 
to  some  recent  experiments  on  man,  the  usual  dose 
of  dilute  hydrochloric  acid,  1 c.c.  (15  minims)  is 
-entirely  too  small  to  supply  the  deficiency  existing 
in  many  cases,  and  as  much  as  200  c.c.  (6  fluid 
ounces)  of  0.4  per  cent,  acid,  corresponding  to  10 
c.c.  of  the  official  dilute  acid,  has  been  given  with 
decided  benefit  when  the  usual  dose  or  less  had 
given  no  appreciable  result.  It  must  always  be 
given  diluted  with  a large  amount  of  water.  It 
should  be  remembered  that  mineral  acids  are  to  be 
taken  through  a tube  to  avoid  injury  to  the  teeth, 
and  that  the  mouth  should  then  be  rinsed  with 
water,  or,  better  still,  with  a mild  alkaline  solu- 
tion,2 such  as  limewater  or  a very  dilute  solution 
of  sodium  bicarbonate. 

Naphthalenum. — U.  S. — Naphthalene,  naph- 
talin  and 


2.  The  following  has  been  used  to  a considerable  extent 
In  the  treatment  of  gastric  fermentative  dyspepsia,  partic- 
ularly when  accompanied  by  nervous  disturbances : 


R.  Sodii  bromidl  gr.  v 13 

Resorcinoiis  <.  . . gr.  ii  j 1 

Aquse  anisi  q.  s.  ad 3ii  10 1 


This  dose  to  be'  taken  after  meals  in  half  a glass  of  water. 


INTERNAL  ANTISEPTICS. 


61 


Betanaphthol. — IT.  S.  — Betanaphthol,  or 
naphtol,  have  been  highly  recommended  as  intes- 
tinal antiseptics.  As  we  have  seen,  they  do  not 
usually  lessen  the  number  of  bacteria,  though  they 
may  exert  a favorable,  modifying  action.  These 
substances  have  been  used  in  the  treatment  of  diar- 
rhea with  excessive  putrefaction. 

The  average  dose  of  naphthalene  is  given  as 
0.12  gm.  (2  grains),  and  the  average  dose  of  beta- 
naphthol as  0.25  gm.  (4  grains).  It  has  been  sug- 
gested that  naphthalene  must  be  converted  into 
betanaphthol  before  it  can  exert  its  antiseptic  ac- 
tion, but  even  this  point  has  not  been  satisfactorily 
determined. 

There  are  a number  of  nostrums  on  the  market 
consisting  of  betanaphthol  combined  with  astring- 
ents, but  in  view  of  the  complex  nature  of  the  prob- 
lem with  which  we  have  here  to  deal  it  is  preferable 
by  far  to  employ  the  official  substances,  combining 
them  as  seems  indicated  in  each  case.  To  do  this 
it  is  merely  necessary  to  calculate  the  relative 
amount  of  each  powder  to  be  given  at  a dose  and 
to  dispense  them  either  separately  or  in  a single 
powder  or  a mixture. 

Betanaphthol  and  bismuth  subnitrate  or  subcar- 
bonate may  be  combined  somewhat  as  follows : 


R.  Bismuthi  subnitratis  3i  4| 

Betanaphthol  gr.  xv  1[ 

M.  Sig. : To  be  made  into  ten  powders,  one  being 

given  every  two  hours  in  diarrhea  and  with  foul-smelling 
feees. 

R.  Bismuthi  subnitratis  3iiss  10 [ 

Betanaphthol  3ss  2| 

Syrupi  acaciae  Biss  50 1 

Aquae  camphorae  to  make Biii  1 00 1 


One  teaspoonful  to  be  given,  after  shaking,  every  two 
hours. 


02 


PHARMACOPEIA  AM)  PHYSICIAN. 


The  number,  as  well  as  the  variety  of  substances 
that  have  been  suggested  from  time  to  time  as  in- 
testinal antiseptics  may  perhaps  justify  a more  ex- 
tended review ; we  can  do  little  more,  however,  than 
simply  enumerate  some  of  the  official  substances 
that  have  beep,  used  and  are  even  now  being  lauded 
as  valuable  and  efficient  remedies  in  the  treatment 
of  the  several  gastrointestinal  disorders. 

The  use  of  antiseptics  in  the  treatment  of  ty- 
phoid and  typhus  fevers  was  first  suggested  in  Ger- 
many more  than  thirty  years  ago.  and  the  argu- 
ments that  were  offered  at  that  time  appeared  so 
plausible  that  internal  antiseptics  at  once  sprang 
into  vogue.  Among  the  more  popular  were  the  fol- 
lowing : 

Iodum. — IT.  S. — Iodin  is  very  seldom  used  as 
such  at  the  present  time,  although  it  is  official. 

Average  dose:  0.005  gm.  (5  mg.,  1/10  grain). 

Liquor  Iodt  Compositus. — U.  S. — Compound 
Solution  of  Iodin,  better  known  as  Lugol’s  solution, 
contains  about  5 per  cent,  of  iodin  and  10  per  cent, 
of  potassium  iodid  in  distilled  water.  This  was  at 
one  time  a favorite  method  of  administering  iodin. 

Average  dose:  2 c.c.  (3  minims). 

Tinctura  Iodi. — U.  S. — Tincture  of  Iodin  is 
virtually  a new  preparation  and  combines  the 
strength  of  the  former  official  tincture  with  the 
water-soluble  properties  of  the  unofficial  compound 
tinctures,  or  soluble  iodin  solutions.  It  contains  7 
per  cent,  of  iodin  and  5 per  cent,  of  potassium  iodid 
in  alcohol. 

Average  dose:  0.1  c.c.  (IV2  minims). 

Iodin  and  the  water-soluble  preparations  of  iodin 
were  formerly  much  lauded  as  intestinal  antisep- 
tics, and  even  at  the  present  time,  though,  as  was 


INTERNAL  ANTISEPTICS. 


G3 


shown  in  the  introductory  portion  of  this  article, 
the  practice  is  now  obsolete,  they  are  frequently  ex- 
ploited by  manufacturers  of  nostrums  as  being  lit- 
tle short  of  the  ideal.  The  form  in  which  iodin 
was  formerly  largely  used  was  in  connection  with 
carbolic  acid  or  phenol,  thus : 

R.  Tinct.  iodi  3iiss  10 1 

Phenol  m.  lxxv  5\ 

M.  Sig. : y2  to  iy2  minim  three  times  a day  in  water. 

Phenol  itself  is  now  seldom  employed,  or  even 
recommended,  as  an  intestinal  antiseptic,  but  the 
official  phenol  sulphonates,  better  known  as  sulpho- 
earbolates,  still  have  a number  of  ardent  advocates. 

Sodii  Piien'olsulphonas. — U.  S. — Sodium 

Phenolsulphonate,  the  sodium  sulphocarbolate  of 
the  previous  Pharmacopeia. 

Average  dose:  0.25  gm.  (4  grains). 

Zixci  Phenolsulphonas. — U.  S. — Zinc  Phe- 
nolsulphonate, is  rather  more  active  than  the 
sodium  salt,  combining  the  astringent  properties 
of  the  zinc  with  the  antiseptic  properties  of  the 
phenolsulphonie  acid. 

Average  dose:  0.12  gm.  (2  grains): 

Both  the  official  salts  are  readily  soluble  in  water 
and  may  be  given  in  solution.  Calcium  phenol- 
sulphonate is  being  lauded  at  the  present  time  as  an 
intestinal  antiseptic,  but  there  is  no  reason  to  be- 
lieve that  it  offers  any  advantages  over  the  sodium 
salt,  and  it  is  probably  quite  as  harmless. 

Of  the  official  derivatives  or  substances  coming 
directly  under  the  same  classification  as  phenol  we 
have : 

Thymol. — U.  S.— 

Average  dose:  0.12  gm.  (2  grains). 


64 


PHARMACOPEIA  AND  PHYSICIAN. 


Ceeosotum. — U.  S. — 

Average  dose:  0.2  c.c.  (3  minims), 

Gtjaiacol. — U.  S. — 

Average  dose:  0.5  c.c.  (8  minims),. 

Guaiacolis  Carbonas. — U.  S. — 

Average  dose  : 1 gm.  (15  grains), 

Acidum  Salicylicum. — IT.  S.— 

Average  dose:  0.50  gm.  (Ingrains), 

Phenylis  Salicylas. — IT.  S. — Phenyl  Salicy- 
late, better  known  by  its  former  official  title,  salol, 
is  even  now  considered  as  being  among  the  few 
really  desirable  or  available  internal  antiseptics. 
It  occurs  as  a white  crystalline  powder,  having  a 
faint  but  characteristic  odor  and  a slight,  rather 
peculiar  taste;  it  is  only  slightly  soluble  in  water, 
and,  therefore,  does  not  dissolve  to  any  appreciable 
extent  in  the  juices  of  the  stomach.  It  is  decom- 
posed, however,  by  the  alkaline  liquids  of  the  intes- 
tine into  its  constituents,  phenol  and  salicylic  acid, 
and  thus  becomes  available  as  an  antiseptic.  It  is 
said  to  be  particularly  useful  in  preventing  the  in- 
fection of  the  kidneys  by  the  Bacillus  typhosus. 
Average  dose:  0.50  gm.  (7%  grains). 
Hexamethylenamina. — IT.  S. — Hexamethvl- 
entetramin  will  be  discussed  at  greater  length  un- 
der diuretics  (Chapter  Y).  This  substance  has  also 
been  recommended  as  an  available  intestinal  anti- 
septic, but,  as  noted  under  diuretics,  the  ultimate 
products  of  its  decomposition  are  largely,  if  not  en- 
tirely, eliminated  by  the  kidneys,  and  it  no  doubt 
finds  its  greatest  field  of  usefulness  in  preventing 
possible  infection  of  the  urinary  organs. 

Average  dose:  0.25  gm.  (4  grains). 

Tt  is  manifestly  impossible  to  discuss  or  even  to 
mention  all  the  agents  that  have  been,  or  are,  em- 


INTERNAL  ANTISEPTICS. 


65 


ployed  as  intestinal  antiseptics.  Many  of  the  reme- 
dies that  are  recommended  as  intestinal  antisep- 
tics are  also  useful  as  anthelmintics.  Notable 
among  these  is  thymol,  which  has  been  referred  to 
frequently  of  late  as  being  a useful  as  well  as  an 
efficient  anthelmintic. 

Though  many  efforts  have  been  made  to  treat 
tuberculosis  by  means  of  internal  antiseptics,  the 
favorable  influence  which  has  so  far  been  observed 
is  to  be  attributed  to  the  beneficial  effects  produced 
on  the  tissues,  and  not  to  any  direct  bactericidal 
action  produced  by  the  antiseptics  themselves.  Of 
the  remedies  that  have  been  suggested  for  this  pur- 
pose, creosote  and  guaiacol  continue  to  be  used, 
probably  with  some  benefit. 

The  whole  problem,  however,  appears  to  concern 
curative  effect  and  treatment  rather  than  antisep- 
sis. 

Few  articles  in  our  materia  medica  possess  any 
action  so  specific  as  that  shown  by  cinchona  or  its 
chief  alkaloid,  quinin,  in  the  treatment  of  certain 
forms  of  malarial  fever.  Cinchona  bark  itself 
owes  its  introduction  into  Europe  to  the  fact  that 
it  was  found  to  be  efficient  in  the  treatment  of  fev- 
ers of  a malarial  type.  For  many  years  after  its 
introduction  into  Spain  the  Jesuits  had  the  bark 
sent  to  them  by  their  brethren  in  Peru  and  care- 
fully kept  the  source  of  its  origin  a secret,  and  the 
substance,  therefore,  became  widely  known  as  Jes- 
uits’ b^rk.  Being  virtually  introduced  as  a nos- 
trum, or  secret  remedy,  it  need  not  surprise  us 
when  we  find  that  it  has  frequently  taken  a most 
important  part  as  one  of  the  compotent  parts  of  a 
variety  of  nostrums,  even  down  to  our  own  times. 

Quinin.  the  most  valuable  of  the  alkaloids  of  cin- 


66 


PHARMACOPEIA  AX  I)  PHY  SI  Cl  AX. 


chona,  was  discovered  by  Pelletier  and  Caventon  in 
1820,  and  is  to-day  one  of  the  few  substances  in 
medicine  that  has  met  with  a constantly  increas- 
ing popularity.  Quinin  is  official  under  no  less 
than  six  different  titles,  in  addition  to  the  several 
scale  salts  and  preparations  that  are  not  of  direct 
interest  in  connection  with  its  peculiar  use  in  ma- 
larial fever,  but  which  will  be  mentioned  under  the 
subject  of  bitters. 

Quinina. — U.  S. — Quinin. 

Quinine  Bisulphas. — U.  S. — Quinin  bisul- 
phate. 

Quininye  Hydrobromidum. — U.  S. — Quinin 
hydrobromid. 

Quinine  Hydrochloridum. — U.  S. — Quinin 
hydrochlorid. 

QuiNiNiE  Salicylas. — U.  S. — Quinin  salicy- 
late. 

Quininte  Sulphas. — IT.  S. — Quinin  sulphate. 

Average  dose  of  any  of  these  preparations : 
0.25  gm.  (4  grains). 

The  physical  properties  of  the  several  salts  of 
quinin  are  so  well  known  that  they  do  not  require 
a description  at  this  time.  The  reasons  for  the 
popularity  and  use  of  some  of  these  salts  are  not 
always  apparent.  In  America  the  sulphate  is  used 
almost  exclusively,  while  on  the  continent  of 
Europe  the  hydrochlorid  appears  to  be  given  the 
preference  in  nearly  all  cases.  That  each»of  the 
several  official  preparations  of  quinin  has  some  par- 
ticular point  of  merit  is  suggested  by  the  follow- 
ing table,  showing  the  relative  percentage  of  anhy- 
drous alkaloid  quinin  in  each  and  also  the  relative 
solubility  in  water  and  in  alcohol: 


INTERNAL  ANTISEPTICS. 


07 


Per  cent,  of 

Solubility 

Solubility 

anhydrous  quinin. 

in  water. 

in  alcohol. 

Quinin 

85.5 

1750. 

0.6 

Quinin 

bisulphate.  . . 59.5 

8.5 

18. 

Quinin 

h.vdrobromid . 76.6 

40. 

0.7 

Quinin 

hydrochlorid.  81.5 

IS. 

0.6 

Quinin 

salicylate  . . 69.9 

77. 

11. 

Quinin 

sulphate  . . . 74.3 

720. 

86. 

It  will  be  noted  that  the  very  commonly  nsed 
sulphate,  next  to  the  alkaloid  itself,  is  the  least 
soluble  in  the  most  common  of  all  solvents,  water : 
this,  while  a decided  advantage  so  far  as  masking 
the  taste  of  salt  is  concerned,  is  a marked  disad- 
vantage in  attempting  to  make  a solution  of  the 
salt.  Where  quinin  sulphate  is  to  be  given  in  so- 
lution it  must  be  given  in  an  acid  mixture  or  in 
solutions  that  are  so  dilute  that  the  quantity  to  be 
taken  would  be  nauseating.3 

3.  It  is  truly  surprising  that  the  sulphate  of  quinin  con- 
tinues to  be  nsed  almost  to  the  exclusion  of  the  alkaloid  and 
the  other  salts.  When  a tasteless  mixture  is  desired  the  alka- 
loid Is  preferable  because  it  is  less  soluble  than  any  of  the  offi- 
cial salts  ; if  it  is  necessary  to  administer  the  drug  in  solution 
ten  grains  of  the  h.vdrochlorid  may  be  given  in  a teaspoonful 
of  a mixture  containing  50  per  cent,  of  alcohol,  while  three 
grains  of  the  hydrochlorid,  or  seven  of  the  bisulphate  may 
be  given  in  a teaspoonful  of  a watery  mixture.  The  follow- 
ing is  a type  of  the  usual  acid  mixture  : 

R.  Quinin  sulphatis  grs.  Ixxv  51 

Acidi  hydrochlorici  dil m.  ixxv  5] 

Elix.  aromat.  q.  s Siii  100 1 

When  the  salt,  or  better,  the  alkaloid,  is  to  be  given  in  a 
mixture,  and  the  taste  is  to  be  masked,  acids  should  never 
be  added.  Instead  of  the  acid,  a sweet  substance,  like  gl.v- 
cyrrhizin,  should  be  used  to  mask  the  bitter  taste  of  the  qui- 
nin. A satisfactory  mixture  is  obtained  as  follows : 

R.  Quininre  vel  quininm  sulphatis.  .grs.  ixxv  51 


Fid.  ext.  glycyrrhizae 3iv  15 

Syrupi  et  elix.  aromat.  aa  q.  s 3ii  100 


The  more  satisfactory  method  of  administering 
quinin  in  the  comparatively  large  quantities  that 
are  usually  given  is  in  cachets,  gelatin  capsules  or 
pills. 


68 


PHARMACOPEIA  AND  PHYSICIAN. 


The  use  of  quinin  as  a destroyer  of  the  proto- 
zoon  which  causes  malarial  fever  is  among  the  best 
established  facts  of  therapeutics.  It  is  mentioned 
here  largely  to  avoid  the  criticism  of  incomplete- 
ness rather  than  to  offer  any  suggestions  of  nov- 
elty to  the  general  practitioner. 

If  fairly  large  doses  of  quinin  be  given  four 
hours  before  the  time  at  which  the  chill  of  malarial 
fever  is  expected  to  occur,  and  the  dose  repeated  in 
two  hours,  the  maximum  effect  of  the  quinin  on 
the  organism  is  obtained  and  the  chill  is  usually 
prevented.  The  quinin  existing  in  the  blood  at  the 
time  that  sporulation  occurs  destroys  the  newly 
liberated  organisms  and  the  blood  is  rendered  asep- 
tic so  far  as  that  particular  organism  is  concerned. 
This  process  has  to  be  repeated  at  intervals,  some- 
times for  three  or  four  weeks. 

The  use  of  salicylates  in  articular  rheumatism  is 
almost  as  well  established  as  is  that  of  quinin  in 
malarial  fever.  The  precise  mode  of  action  is  not 
known,  but  it  is  surmised  that  its  action  is  some- 
what analogous  to  that  of  quinin.  We  may  be  per- 
mitted to  add  a list  of  the  official  preparations  that 
would  properly  come  under  this  heading,  just  to 
show  the  extensiveness  as  well  as  the  variety  of  the 
official  preparations.  Surely  such  a variety  as  we 
find  here  should  enable  us  to  choose  the  appropriate 
remedy  of  this  type  without  the  necessity  of  hav- 
ing recourse  to  any  of  the  nostrums. 

Acidum  Salicylictjm. — U.  S. — 

Average  dose:  0.5  gm.  (7%  grains). 

Sodii  Salicylas. — U.  S. — 

Average  dose:  1 gm.  (15  grains). 

Ammonii  Salicylas. — IT.  S. — 

Average  dose:  0.25  gm.  (4  grains). 


INTERNAL  ANTISEPTICS. 


69 


LlTHII  SaLICYLAS.— IT.  S — 

Average  dose:  1 gm.  (15  grains). 

Strontii  Salicylas. — U.  S. — 

Average  dose:  1 gm.  (15  grains). 

Pitenylis  Salicylis. — U.  S. — Salol  (U.  S.  P., 
1890). 

Average  dose:  0.5  gm.  (7%  grains). 
Methylis  Salicylis. — U.  S. — 

Average  dose:  1 c.c.  (15  minims). 

Oleum  Betur-ee. — U.  S. — 

Average  dose:  1 c.c.  (15  minims). 

Oleum  Gaultherije. — U.  S. — 

Average  dose:  1 c.c.  (15  minims). 

Saliciyum. — U.  S. — 

Average  dose:  1 gm.  (15  grains). 

The  mercurials  will  be  discussed  under  the  sub- 
ject of  alteratives. 


CHAPTER  IV. 


GENERAL  TONICS. 

Tonics  are  defined  by  Gould  as  “medicines  or 
agents  which  promote  nutrition  and  give  tone  to 
the  system.” 

Since  these  conditions  are  met  bjr  any  improve- 
ment in  the  general  health,  the  use  of  the  term  is 
often  an  admission  of  our  want  of  exact  knowledge 
of  the  mode  of  action  of  the  drugs  or  remedies  so 
classed. 

Strychnin  increases  the  reflexes  and  may  thus 
improve  the  muscular  tone.  Bitters  may  increase 
the  impaired  appetite  and  digestion,  which  will,  of 
course,  improve  the  general  condition,  hence  these 
agents  may  be  spoken  of  as  tonics ; and,  if  we  were 
not  acquainted  with  the  organism  which  causes 
malarial  fever,  and  with  the  effect  of  quinin  on 
that  organism,  but  merely  knew  that  this  condi- 
tion was  relieved  by  quinin,  we  would  be  justified 
in  attributing  the  action  to  the  tonic  effect  of 
quinin.  Therefore,  as  our  knowledge  of  the  exact 
mode  of  action  of  the  various  remedies  of  this 
group  increases,  the  importance  of  the  term  itself 
will  correspondingly  decline. 

Among  the  tonics  we  may  include  stomachics, 
hematinics,  or  agents  which  assist  in  the  regen- 
eration of  blood,  including  iron,  arsenic,  codliver 
oil  and  hypophosphites,  and  the  alteratives,  the 
mode  of  action  of  which  is  unknown. 


HEMATINICS. 


71 


HEMATINICS. 

Ordinary  food  is  the  most  important  of  the 
hem  at  ini  cs,  if,  indeed,  we  have  any  others  which 
are  of  considerable  importance,  especially  if  we  ac- 
cept the  definition  which  includes  iron  in  any  as- 
similable form  as  food. 

iROisr. 

Most  of  the  iron  in  the  body,  amounting  to  from 
2y2  to  3 grams,  (38  to  45  grains),  occurs  as  a con- 
stituent of  hemoglobin,  an  extremely  complex  sub- 
stance in  which  the  iron  is  much  more  firmly 
bound  than  in  the  ordinary  iron  albuminate.  In 
addition  to  that  found  in  the  blood,  iron  is  an  im- 
portant constituent  of  the  body  cells,  though  pres- 
ent only  in  very  minute  quantity. 

The  animal  body  is  generally  supposed  to  be  in- 
capable of  building  up  complex  organic  molecules 
from  elementary  substances,  and  it  seems  more 
than  probable  that  all  the  iron  in  the  hemoglobin 
is  derived  from  the  vegetable  kingdom,  and  that 
inorganic  salts  of  iron  do  not  take  part  directly  in 
its  formation,  though  they  may  influence  it 
markedly.1 

The  absorbability  of  inorganic  iron  was  not 
questioned  before  the  investigations  of  Kletzinsky, 
about  fifty  years  ago,  and  it  is  even  more  recently 
that  the  subject  began  to  attract  considerable  at- 
tention, but  the  literature  at  the  present  time  is 
rather  extensive  and  many  contradictory  results 
have  been  obtained. 

It  is  perfectly  obvious  that  iron  as  it  exists  in 

1.  Prior  to  the  discovery  of  Wohler  of  the  synthesis  of 
such  a comparatively  simple  substance  as  hippuric  acid  in 
the  kidney,  it  was  supposed  that  no  synthesis  could  occur  in 
the  animal  body. 


72 


PHARMACOPEIA  AND  PHYSICIAN. 


vegetables  is  capable  not  only  of  being  absorbed, 
but  of  being  utilized  in  the  formation  of  hemo- 
globin, and  it  is  only  when  the  appetite  or  diges- 
tion is  greatly  impaired  that  there  can  ever  exist 
any  marked  deficiency  in  the  supply  of  iron,  only 
about  10  milligrams  (1/6  grain)  being  required 
daily  under  ordinary  conditions,  but  there  may 
arise  the  necessity  for  a stimulation  of  the  function 
concerned  in  the  utilization  of  the  iron  taken  in 
the  food;  if  inorganic  iron  stimulates  this  func- 
tion, and  it  apparently  does  under  certain  condi- 
tions, then  it  acts  as  a medicine. 

Many  efforts  have  been  directed  toward  deter- 
mining whether  ' iron,  other  than  that  existing  in 
the  food,  is  absorbed  from  the  alimentary  canal. 
Attempts  to  measure  the  difference  between  the 
amount  ingested  and  that  excreted  proved  incon- 
clusive. Iron  is  probably  excreted  into  the  intes- 
tine after  absorption,  though  Tartakowsky  doubts 
if  the  iron  found  in  the  intestinal  epithelium  is 
in  course  of  excretion,  and  the  amount  excreted 
often  considerably  exceeds  that  administered. 

Microchemic  means  have  been  employed  to  solve 
the  problem,  and  A.  B.  MacCallum  has  found  that 
only  a slight  degree  of  absorption  in  the  first  few 
inches  of  the  duodenum  follows  the  administration 
of  small  doses  of  inorganic  iron,  nearly  all  being 
precipitated  by  the  mixed  chyme,  pancreatic  juice 
and  bile,  but  when  large  doses  are  taken  absorption 
appeared  to  take  place  throiagh  the  whole  length 
of  the  small  intestine,  while  Tartakowsky  found 
that  inorganic  iron  was  also  absorbed  from  the  rab- 
bit’s stomach. 

MacCallum  found  that  iron,  in  the  form  in 
which  it  exists  in  yolk  of  egg,  is  absorbed,  while 


HEMATINICS. 


73 


Marfori’s  albuminate  and  the  commercial  pepton- 
ate  seemed  to  stimulate  the  leucocytes  to  invade  the 
epithelial  layer  of  the  villi  in  the  guinea-pig,  but 
many  investigators  now  believe  that  absorption 
occurs  mainly  by  way  of  the  lymph  channels  and 
not  by  the  blood. 

Since  iron,  like  any  other  foreign  substance, 
may  be  excreted  without  having  been  utilized  after 
absorption,  the  question  is  not  one  of  absorption 
alone,  but  of  the  form  in  which  iron  must  be  ab- 
sorbed in  order  that  it  may  take  part  in  the  forma- 
tion of  hemoglobin,  and  be  utilized  in  the  body 
cells. 

In  addition  to  the  food  irons,  the  assimilation 
of  which  it  is  not  necessary  to  discuss  at  present, 
certain  other  forms  have  been  found  capable  of 
being  converted  into  hemoglobin,  and  we  may  say 
that  many  physiologic  chemists  believe  that  there 
is  no  reason  to  suppose  that  inorganic  salts  of  iron 
are  not  as  readily  assimilated  as  are  the  organic, 
and  Tartakowsky  does  not  believe  that  even  the 
food  irons  are  absorbed  in  the  form  of  the  complex 
combinations  in  which  they  exist  in  plants. 

Socin,  working  in  Bunge’s  laboratory,  proved 
that  iron,  in  the  form  in  which  it  exists  in  yolk 
of  egg  (hematogen,  as  it  is  called  by  Bunge,  who 
isolated  it),  is  capable  of  assimilation.  He  fed 
this,  and  no  other  form  of  iron,  to  mice  for  a 
period  of  100  days,  during  which  time  they  gained 
in  size  and  weight  without  becoming  anemic. 

Bunge  considers  that  hematogen  is  the  un- 
doubted precursor  of  hemoglobin,  but  his  views 
have  not  been  universally  accepted.  Hematogen. 
according  to  the  investigations  that  have  been 
made  by  Bunge,  is  more  stable  than  the  combina- 


74 


PHARMACOPEIA  AND  PHYSICIAN. 


tions  of  iron  that  are  found  in  vegetables  and  it  is 
also  more  easily  isolated. 

Schmiedeberg  isolated  an  organic  iron  com- 
pound, which  he  named  ferratin,  from  the  liver, 
and  which  he  considers  the  true  precursor  of  hemo- 
globin. Ferratin  may  be  prepared  synthetically 
from  an  alkaline  solution  of  albuminate  of  iron, 
and  is  usually  considered  merely  as  an  ordinary 
albuminate,  but  Schmiedeberg  strong^  insists 
that  it  is  iron-acid-albumin,  and  calls  attention  to 
certain  chemic  differences  between  it  and  the  or- 
dinary albuminate.  Marfori  isolated  the  com- 
pound containing  0.7  per  cent,  of  iron,  but  as  most 
easily  prepared-  it  contains  from  4 to  8 per  cent., 
which  strongly  suggests  that  the  precipitate  carries 
down  mechanically  some  other  form  of  iron. 

The  examples  quoted  serve  to  show  the  diversity 
of  opinion  among  authorities  as  to  the  actual  pre- 
cursor of  hemoglobin,  but  the  question  is  of  less 
therapeutic  importance  than  it  would  seem  at  first 
thought,  in  view  of  the  fact  that  it  is  a compara- 
tively infrequent  occurrence  that  a patient  is  un- 
able to  take  a sufficient  amount  of  iron  in  the  food. 
We  have  devoted  so  much  space  to  the  subject 
mainly  because  the  manufacturers  of  certain  nos- 
trums, used  as  hematinics,  are  prone  to  quote  such 
results  as  those  obtained  in  Bunge’s  laboratory 
only  so  far  as  they  show  that  organic  iron  prepara- 
tions are  assimilable  while  the  inorganic  are  not, 
but  we  have  not  yet  seen  any  mention  made  in  the 
free  circulars  of  the  statement  made  by  Bunge 
that  inorganic  iron  does  stimulate  the  functions 
concerned  in  the  assimilation  of  iron  when  it  is 
abundant  in  the  food,  and  that  organic  iron  pre- 


hem  Any  IC\S. 


partitions  are  without  beneficial  effect  under  sim- 
ilar conditions. 

This,  however,  is  of  the  very  greatest  importance 
from  a practical  point  of  view,  because-  we  can 
nearly  always  select  a suitable  diet  containing  an 
abundance  of  iron,  and  organic  iron  in  any  other 
shape  is,  therefore,  seldom  if  ever  recpiired. 

As  evidence  of  the  role  played  by  inorganic  iron 
we  may  mention  the  results  obtained  by  Abder- 
halden. 

He  found  that  the  iron  of  hematin  and  hemo- 
globin is  not  so  readily  assimilated  as  is  that  of 
the  ordinary  food.  Animals  were  fed  on  a diet  in 
which  a deficiency  of  iron  was  made  up  by  hematin 
and  hemoglobin,  and  they  did  not  thrive  so  well 
as  those  which  received  food  containing  a suffi- 
ciency of  iron,  though  those  which  received  hema- 
tin and  hemoglobin  did  thrive  better  than  those  in 
which  the  deficiency  was  made  up  by  an  inorganic 
iron.  This  might  be  easily  considered  as  conclu- 
sive proof  of  the  value  of  organic  iron  nostrums, 
but  when  we  repeat  that  it  rarely  happens  that  the 
patient  can  not  take  food  containing  an  abundance 
of  iron -the  fact  loses  most  of  its  significance. 

When  the  food  was  rich  in  iron  the  addition  of 
hematin  and  hemoglobin  (which  may  be  consid- 
ered the  best  type  of  organic  iron)  had  no  effect 
on  the  assimilation  of  the  food  iron,  but  when  in- 
organic iron  was  added  to  such  iron-rich  food  the 
assimilation  was  stimulated.2 

2.  Cushny  : “Pharmacology  and  Therapeutics”  says  : “The 
words  organic  and  inorganio  in  connection  with  these  prepara- 
tions have  no  reference'  to  the  combination  to  which  iron  is 
attached,  hut  to  the  method  of  attachment.  Thus  the  acetate 
and  albuminate  of  iron  are  both  classified  among  the  inor- 
, ganic  iron  compounds,  because  they  are  capable  of  dissocia- 


76 


PHARMACOPEIA  AND  PHYSICIAN. 


When  inorganic  iron  is  added  to  the  food  or  to 
organic  iron,  it  combines  with,  the  hydrogen  sul- 
phid  in  the  intestine  and  spares  the  organic  iron 
from  precipitation.  Inorganic  iron  should  thus 
prove  beneficial  even  if  Schmiedeberg  were  cor- 
rect in  contending  that  inorganic  iron  is  not  ob- 
sorbed  from  the  intestine  except  after  corrosion  of 
the  mucons  membrane.  He  claims  that  corrosion 
occurs  even  when  such  a salt  as  ferric  chlorid  is 
administered  after  free  dilution,  because  the  water 
is  rapidly  absorbed,  leaving  the  salt  in  concen- 
trated solution. 

Other  investigators  have  also  called  attention 
to  the  corrosive  action  of  hydrochloric  acid  when 
liberated  from  a metallic  salt  in  contact  with  the 
tissues,  and  it  may  be  found  that  the  ferrous  sul- 
phate or  carbonate  may  be  found  to  be  preferable 
to  the  more  widely  used  ferric  chlorid. 

OFFICIAL  PREPARATION'S  OF  IRON-.  ' 

The  list  of  official  preparations  of  iron  is  a long 
one  and  comprises  a number  of  substances  that 
are  not  generally  used  as  hematinics. 

The  use  of  the  salts  of  iron  as  astringents  will 
be  referred  to  in  Chapter  Y,  and  need  not  be 

tion,  and  the  iron  is  precipitated  by  ammonium  sulphid. 
Masked  iron  is  a preferable  term  for  organic  iron,  but  has 
not  been  so  widely  used.  A large  number  of  the  proteid  com- 
pounds that  have  been  introduced  in  the  last  few  years 
promise  to  be  relegated  to  merited  oblivion  in  the  near  future. 
The  albuminate  of  iron  and  the  peptonate  of  iron  are  gen- 
erally prepared  by  the  action  of  the  chlorid  on  egg  albumin 
or  on  peptone,  and  differ  very  considerably  in  the  percentage 
of  iron.  These  preparations  are  not  organic  iron  in  the 
sense  defined  above,  for  the  iron  can  be  split  off  easily,  and 
Is  precipitated  by  sulpbids  almost  as  readily  as  the  ordinary 
salts.” 


HEMATINIGS. 


77 


considered  at  this  time  more  than  to  enumerate 
the  preparations  that  may  be  so  used. 

Among  the  official  preparations  that  are  useful 
as  astringents  or  as  stypics  are : 

LrQuoR  Ferri  Subsulphatis. — IT.  S. — The 
solution  of  ferric  subsulphate,  better  known  as 
Monsel’s  solution,  in  addition  to  being  used  as  an 
astringent  and  styptic,  has  also  been  recommended 
as  a hematinic. 

Average  dose:  0.2  c.c.  (3  minims). 

Probably  the  most  widely  used  of  the  several 
preparations  of  iron,  is : 

Tinctura  Ferri  Chloridi. — U.  S. — This 

preparation  contains  35  per  cent,  by  volume  of 
solution  of  ferric  chlorid  and  should  be  prepared 
at  least  three  months  before  being  used.  Tincture 
of  ferric  chlorid,  or  tincture  of  iron,  as  it  was  for- 
merly called,  has  long  been  considered  one  of  the 
most  efficient  of  the  inorganic  iron  preparations. 

Average  dose:  0.5  c.c.  (8  minims). 

Ferri  Sulphas  and  Ferri  Sulphas  Granu- 
latus. — U.  S. — These  differ  only  in  the  size  of  the 
crystals ; they  consist  of  ferrous  sulphate  contain- 
ing 7 molecules  of  water  of  crystallization.  Ferrous 
sulphate  is  soluble  in  less  than  one  part  of  water, 
hut  is  insoluble  in  alcohol. 

Average  dose:  0.2  gm.  (3  grains). 

Ferri  Sulphas  Exsiccatus. — U.  S. — Exsic- 
cated Ferrous  Sulphate  is  a grayish-white  powder 
that  is  slowly  but  completely  soluble  in  water. 
About  65  grams  of  the  exsiccated  preparation  are 
equivalent  to  100  grams  of  the  granulated. 

Average  dose:  0.12  gm.  (2  grains). 

Pilule  Aloes  et  Ferri. — U.  S. — Each  pill 
contains  0.07  gm.  (about  1 grain)  each  of  exsic- 


PHARMACOPEIA  AND  PHYSICIAN. 


cated  ferrous  sulphate,  purified  aloes  and  aromatic 
powder. 

Average  dose : 2 pills. 

PiLULiE  Ferri  Carbonatis. — U.  S. — This 

preparation  is  variously  known  as  Blaud’s  pills, 
Griffith’s  pills  or  Vallet’s  pills.  Each  pill  contains 
about  0.06  gm.  (1  grain)  of  ferrous  carbonate, 
with  potassium  sulphate,  althea  tragacanth  and 
glycerin. 

Average  dose : 2 pills. 

Ferri  Carbonas  Saccharatus. — U.  S. — The 
saccbarated  carbonate  of  iron  should  contain  not 
less  than  15  per  cent,  of  ferrous  carbonate. 

Average  dose;  0.25  gm.  (4  grains). 

Massa  Ferri  Carbonatis. — FT.  S. — Mass  of 
ferrous  carbonate,  better  known  as  Yallet’s  mass, 
contains  nearly  5 per  cent,  of  ferrous  carbonate. 

Average  dose:  0.25  gm.  (4  grains). 

Misttjra  Ferri  Composita. — IT.  S. — Com- 

pound iron  mixture,  or  Griffith’s  mixture,  is  much 
more  popular  in  England  than  in  this  country.  It 
contains  freshly  precipitated  ferrous  carbonate  sus- 
pended in  a mixture  of  potassium  sulphate,  myrrh, 
syrup,  spirit  of  lavender  and  rose  water. 

Average  dose:  16  c.c.  (4  fluidrams). 

Of.  the  several  official  preparations  containing 
ferrcus  carbonate  the  pill  of  ferrous  carbonate, 
more  generally  known  as  Blaud’s  pill,  is  probably 
the  most  efficient  and  most  satisfactory.  This  pill 
should  he  freshly  prepared  and  should  not  contain 
free  or  unchanged  ferrous  sulphate  or  potassium 
carbonate.  The  practice  that  has  been  adopted  by 
some  manufacturers  of  massing  these  pills  with- 
out allowing  the  chemical  reaction  to  take  place  is 
a reprehensible  one,  as  it  is  not  at  all  probable 


EEMATINICS. 


79 


that  the  necessary  reaction  will  take-  place  as 
readily  in  the  acid  medium  of  the  stomach  as  it 
would  in  a test-tube  or  mortar. 

Ail  the  preparations  of  ferrous  carbonate  have 
the  decided  advantage  over  the  previously  men- 
tioned preparations  of  iron  that  they  are  not 
astringent  and,  therefore,  are  not  likely  to  cause 
digestive  disturbances. 

Another  preparation  that  is  free  from  the  ob- 
jectionable feature  of  being  astringent  is : 

Ferrum  Reductum. — U.  S. — Reduced  Iron  oc- 
curs as  a fine  grayish-black  lusterless  powder  with- 
out odor  or  taste.  It  is  insoluble  in  water  and  in 
alcohol  and,  therefore,  is  generally  directed  to  he 
dispensed  in  powders,  capsules  or  pills. 

Average  dose:  0.05  gm.  (1  grain). 

SCALE  SALTS  Oy  IRON. 

Ferri  Citras. — FT.  S.— Ferric  Citrate  occurs  in 
thin  garnet-red  scales  that  are  slowly  but  com- 
pletely soluble  in  water. 

Average  dose:  0.25  gm.  (4  grains). 

Ferri  et  Ammonii  Citras. — U.  S. — Iron  and 
Ammonium  Citrate  is  much  more  freely  soluble  in 
water  than  the  simple  citrate,  and  has  the  added 
advantage  that  it  is  not  likely  to  lose  this  property 
on  keeping. 

Average  dose:  0.25  gm.  (4  grains). 

Ferri  et  Ammonii  Tartras. — U.  S. — This 
occurs  in  thin  transparent  scales  varying  in  color 
from  garnet  red  to  reddish  brown.  It  is  freely 
soluble  in  water  but  insoluble  in  alcohol. 

Average  dose:  0.25  gm.  (4  grains). 

Ferri  et  Potassii  Tartras. — U.  S. — This  is 


80 


PHARMACOPEIA  AND  PHYSICIAN. 


very  similar  in  physical  properties  to  iron  and  am- 
monium tartrate. 

Average  dose:  0.25  gm.  (4  grains). 

Ferri  et  Quinine  Citras. — U.  S. — Iron  and 
Quinin  Citrate  contains  about  11.5  per  cent,  of 
quinin  and  ferric  citrate  corresponding  in  amount 
to  13.5  per  cent,  of  metallic  iron.  It  is  slowly  but 
completely  soluble  in  water. 

Average  dose:  0.25  gm.  (4  grains). 

Ferri  et  Quinine  Citras  Solubilis. — U.  S. — 
This  preparation  has  practically  the  same  compo- 
sition as  iron  and  quinin  citrate,  but  with  am- 
monium citrate  present  to  insure  its  ready  and 
complete  solubility. 

Average  dose:  0.25  gm.  (4  grains). 

Ferri  et  Strychnine  Citras. — U.  S. — Iron 
and  Strychnin  Citrate  contains  about  1 per  cent,  of 
strychnin.  It  is  readily  and  completely  soluble  in 
water. 

Average  dose:  0.12  gm.  (2  grains). 

These  several  scale  preparations  of  iron  are  com- 
paratively free  from  astringent  properties,  are  gen- 
erally freely  soluble  in  water,  do  not  attack  the 
teeth,  and  are  not  obnoxious  to  the  taste.  They 
are  preferably  directed  to  be  dispensed  in  aqueous 
solution,  with  or  without  the  addition  of  elixir  or 
some  other  flavoring  admixture. 

liquid  preparations  of  iron. 

Yinum  Ferri. — U.  S. — This  contains  4 per 
cent,  of  iron  and  ammonium  citrate  with  syrup 
and  white  wine,  flavored  with  tincture  of  sweet 
orange  peel. 

Average  dose:  8 c.c.  (2  fluidrams). 

Yinum  Ferri  Amarum. — IT.  S. — This  prepara- 


HEMATINICS. 


81 


tion  contains  5 per  cent,  of  soluble  iron  and  quinin 
citrate  with  svrup  and  white  wine,  flavored  with 
tincture  of  sweet  orange  peel. 

Average  dose:  8 c.c.  (2  fluidrams). 

Glyceritum  Ferri  Quinine  et  Strychnine 
Phosphatum. — U.  S. — The  Glycerite  of  the  Phos- 
phates of  Iron,  Quinin  and  Strychnin  contains  8 
per  cent,  of  the  soluble  ferric  phosphate,  10  per 
cent,  of  quinin  and  0.08  per  cent,  of  strychnin 
with  phosphoric  acid,  glycerin  and  water. 

Average  dose:  1 c.c.  (15  minims). 

Syrupus  Ferri,  Quinine  et  Strychnine 
Phosphatum. — U.  S. — This  syrup  contains  25 
per  cent,  of  the  glycerite  of  the  phosphates  of  iron, 
quinin  and  strychnin  in  syrup. 

Average  dose:  4 c.c.  (1  fluidram). 

Elixir  Ferri,  Quinine  et  Strychnine 
Phosphatum. — U.  S. — This  popular  ferruginous 
bitter  tonic  contains  soluble  ferric  phosphate, 
quinin  and  strychnin.  The  average  dose — 4 c.c. 
(1  fluidram) — contains  nearly  0.07  gm.  (1/16  gr.) 
of  soluble  ferric  phosphate,  0.035  gm.  (7/12  gr.) 
of  quinin,  and  0.001  gm.  (1/60  gr.)  of  strychnin. 

Average  dose:  4 c.c.  (1  fluidram). 

Liquor  Ferri  et  Ammonii  Acetatis. — IJ.  S. — - 
This  Solution  of  Iron  and  Ammonium  Acetate, 
more  popularly  known  as  Basham’s  mixture,  con- 
tains a double  salt  of  iron  and  ammonium  acetate 
and  is  directed  to  be  made  by  mixing  4 parts  of 
tincture  of  ferric  chlorid,  6 parts  of  diluted  acetic 
acid,  50  parts  of  solution  of  ammonium  acetate,  12 
parts  of  aromatic  elixir,  12  parts  of  glycerin  and  a 
sufficient  quantity  of  water  to  make  100  parts.  This 
preparation  being  quite  dilute,  is  not  very  stable 
and  should  be  freshly  prepared  when  wanted. 


82 


PHARMACOPEIA  AND  PHYSICIAN. 


Average  dose:  16  c.c.  (4  flnidrams). 

There  are  two  additional  preparations  of  iron 
that,  while  they  are  not  prescribed  as  hematinics, 
might  well  be  mentioned  in  this  connection. 

ANTIDOTES  FOR  ARSENIC. 

Terri  Hydroxidum. — U.  S. — This  is  the  hy- 
drated oxid  of  iron  of  the  previous  Pharmacopeia 
and  which  is  directed  to  be  made  by  precipitating 
100  parts  of  solution  of  ferric  sulphate  with  133 
parts  of  ammonia  water  that  has  been  diluted  with 
1,000  parts  of  cold  distilled  water.  The  resulting 
precipitate  is  directed  to  be  washed  until  free  from 
soluble  sulphates.  This  preparation  is  not  par- 
ticularly adapted  for  extemporaneous  preparation, 
and,  as  it  does  not  keep  well,  the  following  has 
been  added  as  an  efficient,  extemporaneous  anti- 
dote for  arsenic : 

Ferri  Hydroxidum  cum  Magnesii  Oxido. — 
U.  S. — This  is  directed  to  be  made  by  diluting  40 
parts  of  solution  of  ferric  sulphate  with  125  parts 
of  water,  and  kept  in  a large  well-stoppered  bot- 
tle. The  magnesia  mixture  is  directed  to  be  made 
by  rubbing  10  parts  of  magnesium  oxid  with  suffi- 
cient water  to  make  a smooth  and  thin  mixture, 
then  diluting  it  to  about  700  parts.  When  wanted 
for  use  the  magnesium  oxid  mixture  is  to  be  well 
shaken  and  then  gradually  added  to  the  solution 
of  ferric  sulphate  and  the  resulting  mixture  again 
well  shaken. 

Average  dose : Arsenical  antidote.  120  c.c. 

(4  fluidounces) . 

indications  for  iron. 

Hematinics  are  demanded  when  the  amount  of 
blood  or  of  any  of  its  essential  constituents  have 
been  greatly  reduced. 


HEMATINICS. 


S3 


After  severe  hemorrhage  involving  the  loss  of 
less  than  half  the  blood,  regeneration  takes  place 
rapidly,  if  the  general  condition  of  the  patient  is 
otherwise  good  and  the  food  ample. 

In  accordance  with  a vast  amount  of  clinical 
experience  and  the  results  obtained  by  many  inves- 
tigators, medicinal  iron  (if  we  may  use  the  term) 
is  indicated.  If  the  patient  is  able  to  take  an 
abundance  of  food  rich  in  iron,  inorganic  iron 
alone  may  suffice,  but  if  he  is  unable  to  digest  such 
food,  then  hematin  and  inorganic  iron  should  both 
be  given. 

Iron  has  long  been  used  in  chlorosis,  and  ex- 
perience has  shown  that  it  is  more  useful  in  those 
forms  of  anemia  in  which  the  loss  of  hemoglobin 
is  greater  than  that  of  red  blood  cells;  in  other 
words,  when  the  red  blood  cells  present,  whether 
in  normal  or  diminished  number,  are  individually 
poor  in  hemoglobin. 

As  to  the  form  of  iron  to  be  given,  of  first  im- 
portance is  the  selection  of  food.  Reference  to  the 
table  given  below,  selected  from  Bunge’s  Plrysi- 
ology,3  will  enable  the  physician  to  compute  ap- 


3.  The  following  table,  taken  from  Bunge’s  Physiology, 
gives  the  iron  content  in  milligrams  per  100  grams  of  the 
dried  substance.  Such  substances  as  grapes  will  evidently 
yield  but  little  iron,  since  they  consist  mainly  of  water  : 

Sugar  0.0  Cabbage  (dark  green 

White  of  egg 0.0  leaves)  17.0-30.0 

Rice  1.0-2. 5 Almonds  (blanched)  ....  4.9 

Barley  (hulled)  1.4-1. 5 Almonds  (whole)  9.5 

Barley  (whole)  4.5  Grapes  (Malaga)  5.6 

Oranges  1.5  Potatoes  6.4 

White  bread  (wheat)  ...  1.5  Peas  6. 2-6.6 

Apples  1.9  Beans  (white)  8.3 

Cow's  milk  2.3  Carrots  8.6 

Human  milk  2. 3-3.1  Dandelion  leaves  (used 

Figs  3. 7-4.0  as  salad)  14.3 

Hazel  nuts  (blanched)  . . 4.3  Beef  16.9 

Hazel  nuts  (whole) 12.7  Asparagus  20.0 

Rye  3. 7-4. 9 Yolk  of  egg  10.0-24.0 

Cabbage  (etiolated)  ....  4.5  Spinach  33.0-39.0 

Cabbage  (light  green  Blood  of  swine 226.0 

leaves)  5.6 


84 


PHARMACOPEIA  AND  PHYSICIAN. 


proximately  the  amount  of  food  iron  which  the 
patient  is  receiving,  and  by  computing  the  daily 
normal  loss  at  10  milligrams  he  can  see  about  how 
much  of  this  is  left  for  the  regeneration  of  hemo- 
globin. The  figures  given  are  for  dried  material, 
and  it  is  to  be  remembered  that  green  vegetables 
may  lose  75  per  cent,  or  more  of  their  weight  on 
drying,  while  fatty  substances  (nuts)  will  lose  but 
little. 

If  the  food  contains  an  insufficiency  of  iron 
hematin  should  be  added,  but  if  the  food  supply  is 
abundant  one  of  the  inorganic  forms  of  iron  will 
prove  beneficial.  In  our  choice  of  medicinal  iron 
we  must  be  guided  by  the  individual  case  in  select- 
ing the  one  which  causes  the  least  disturbance  of 
the  digestion.  In  the  absence  of  fever  it  will  sel- 
dom occur  that  the  patient  can  not  take  a selected 
diet  containing  an  ample  supply  of  iron.  If  the 
appetite  and  digestion  are  deficient  stomachics  are 
indicated. 

Inorganic  iron  very  often  gives  better  results  in 
the  first  few  weeks  of  the  administration  than  it 
does  later,  which  may  possibly  be  explained  by  its 
interference  with  the  digestion — a matter  to  be 
guarded  against  carefully.  Large  doses,  if  they 
do  not  disturb  the  digestion,  are  often  required. 

Bunge  distinctly  warns  the  physician  against 
using  high-priced  pharmaceutical  preparations  of 
iron  and  calls  attention  to  the  advantage  of  beef, 
blood  sausage  and  blood. 

While  warm  blood  may  be  tolerated  by  some  in- 
dividuals, the  aversion  to  it  is  frequently  uncon- 
querable and  hematin  seems  to  be  equally  service- 
able in  any  case.4 

4.  A practical  method  for  the  economic  preparation  of  a 
hematin  product  was  described  by  Torald  Sollmann,  in  the 
Am.  Jour,  of  Phar.,  June,  3 902,  p.  275. 


HEMATINICS. 


85 


The  etiology  of  some  of  the  anemias  is  so  ob- 
scure that  treatment  must  be  mainly  empirical, 
but  we  may  feel  reasonably  certain  that  we  shall 
do  more  harm  than  good  if  we  depend  on  the  nos- 
trums so  glowingly  advertised  instead  of  directing 
our  efforts  toward  improving  the  appetite  and  di- 
gestion. The  selection  of  a proper  diet,  together 
with  proper  doses  of  inorganic  iron  in  most  cases, 
or  of  organic  and  inorganic  iron  in  comparatively 
few  cases  in  which  they  are  needed,  will  usually  be 
found  to  he  all  that  is  required. 

When  iron  tends  to  cause  constipation  laxatives 
must  be  employed,  preferably  one  of  the  prepara- 
tions of  cascara  sagrada,  or  the  pills  of  aloes  and 
iron,  one  of  which  may  be  given  three  times  daily. 

As  examples  of  the  innumerable  combinations  in 
which  iron  may  be  prescribed  we  give  the  follow- 


mg: 

R. 

Ferri  sulphatis  exsic 

3i 

4| 

Extracti  nucis  vom. 

Extracti  rhamni  pursh,  aa.  . 

. . gr.  xv 

l| 

M. 

Ft.  pil.  no.  lx.  Sig. : One  pill  half  an 

hour  after 

meals. 

Beduced  iron  or  ferric  citrate,  may  be  substi- 
tuted for  the  dried  ferrous  sulphate,  and  a slightly 
larger  amount  of  aloes  (20  grains — 1.3  gm.)  can 
be  used  in  place  of  the  extract  of  cascara  Sagrada. 
Clinical  experience  seems  to  show  that  a formula 
of  this  kind  is  not  so  useful  in  those  conditions  in 
which  there  is  a deficiency  of  hydrochloric  acid  in 
the  gastric  secretions;  in  such  cases  small  doses, 
from  half  to  one  tea-spoonful,  of  the  solution  of 
iron  and  ammonium  acetate  may  be  given,  after 
meals.  This  preparation  rarely  gives  rise  to  con- 
stipation or  other  symptoms  of  indigestion. 


86 


PHARMACOPEIA  AND  PHYSICIAN. 


The  pills  of  ferrous  carbonate,  Blaud’s  pills, 
may  be  given  either  alone  or  the  mass  of  ferrous 
carbonate,  which  is  practically  identical,  may  be 
used  in  combination  with  such  a laxative  as  the 
extract  of  cascara  sagrada,  in  the  dose  mentioned 
above.  If  desirable  a bitter  substance  such  as  the 
extract  of  nux  vomica  may  also  be  included  as 
follows : 

B.  Massa  ferri  carbonatis 3ii  8| 

Extracti  nucis  vom. 

Extracti  rhamni  pursh,  aa.  . . .gr.  xx  1| 

M.  Ft.  pit.  No.  lx.  Sig. : One  pill  half  an  hour  after 

eating. 

Other  bitter  extracts,  or  other  bitter  substances, 
such  as  quinin  or  strychnin,  and  other  laxatives 
may  be  substituted  for  those  given  above.  A rep- 
resentative formula  for  a pill  of  this  general  com- 
position would  be  as  follows  : 

B.  Ferri  reducti 

Quininse  sulphatis 

Aloe  purifieat,  aa gr.  xlv  31 

Strychnin®  sulph gr.  i 1 06 

Ext.  gentian  q.  s.  Ft.  mass  et  dividenda  in  pil.  No.  lx. 
Sig. : One  pill  three  times  a day,  after  eating. 

While  it  is  true  that  the  salt?  of  the  alkaloids 
might  better  be  substituted  by  the  alkaloids  them- 
selves, the  amount  of  acid  present  is  so  small  that 
it  is  really  of  very  little  moment. 

In  this  same  connection  it  might  be  pointed  out 
that  the  dried  ferrous  sulphate  or  the  ferric  citrate 
may  be  substituted  for  the  reduced  iron,  or,  by 
omitting  the  extract  of  gentian,  the  mixture  may. 
be  directed  to  be  dispensed  as  a powder  in  capsules. 

The  tincture  of  ferric  chlorid  is  best  given  well 
diluted  with  water,  a glass  tube  being  used  to  pre- 
vent the  corrosive  action  of  the  acid  on  the  teeth, 


UEMATIjYICS. 


87 


and  the  mouth  should  then  he  well  rinsed  with 
water,  or  a dilute  solution  of  an  alkali  such  as 
lime  water. 

The  scale  salts  of  iron,  being,  generally,  com- 
binations with  organic  acids,  are  much  less  cor- 
rosive than  the  chlorid,  or  either  of  the  sulphates, 
and  may  frequently  be  used  with  advantage  in 
their  stead.  A representative  formula  for  a simple 
solution  of  this  kind  would  be  as  follows: 


R.  Ferri  et  ammonii  citratis 3i  4| 

Aquoe  dest fid.  3xii  50 j 

Elixir  q.  s.  ad fid.  Siii  1 00  j 


M.  Sig. : One  teaspoonful  three  times  a day,  before 

eating. 

Any  one  of  the  soluble  scale  salts  of  iron  can  be 
substituted  for  the  iron  and  ammonium  citrate, 
and  one  of  the  aromatic  waters  can  be  used  in  place 
of  the  distilled  water,  or  of  the  water  and  the 
elixir. 

The  bitter  wine  of  iron,  given  a few  minutes 
before  meals,  is  an  excellent  ferruginous  stimulant 
of  the  appetite  and  digestion  which  women  will 
usually  find  acceptable. 

MANGANESE. 

Manganese  is  not  absorbed  from  the  alimentary 
canal  after  ordinary  doses,  hence  it  acts  as  a hema- 
tinic  only  in  so  far  as  it  spares  iron  by  uniting 
with  the  sulphur  which  occurs  in  the  intestines  in 
the  form  of  compounds. 

Manganese  would,  therefore,  hardly  deserve  con- 
sideration here  if  it  were  not  for  its  widespread 
use,  thanks  mainly  to  the  skillful  and  none  too 
scrupulous  methods  often  employed  in  the  exploit- 
ation of  certain  nostrums  containing  it. 


88 


PHARMACOPEIA  AND  PHYSICIAN. 


It  is  not  probable  that  manganese  possesses  any 
advantage  whatsoever  over  the  numerous  official 
preparations  of  iron. 

The  so-called  peptonized  manganese  prepara- 
tions, generally  solutions  of  peptone  to  which  some 
salt  of  manganese  has  been  added,  may  be  obtained 
from  reputable  dealers  in  chemicals,  or  may  be 
made  by  any  retail  pharmacist  who  has  the  neces- 
sary educational  qualifications  to  conduct  even  the 
very  simplest  chemical  experiments. 

A mixture  containing  peptone,  iron  and  man- 
ganese, and  one  that  in  many  respects  is  superior 
to  the  preparation  so  extensively  sold  to  the  laity, 
in  this  country,  as  “Peptomangan — Gude,”  has 
been  included  in  the  new  edition  of  the  National 
Formulary,  now  in  press.  When  it  is  desired  to  use 
a'  simple  solution  of  manganese  peptonate,  it  may 
be  prescribed  as  follows : 


IJ.  Mangani  peptonati  3v  20 1 

:Syrupi  aurantii  oxii  50 1 

Aquae  dest.  q.  s.  ad 300 1 


M.  Sig. : One  tablespoonful  after  each  meal. 

It  should  be  remembered,  however,  that  dry 
preparations  of  peptonates  of  iron  or  manganese 
do  not  keep  well,  and  it  will  usually  be  preferable 
to  have  a reliable  pharmacist  prepare  a solution, 
similar  to  the  compound  solution  of  peptonate  of 
iron  with  manganese,  of  the  National  Formulary, 
Avhich  is  preserved  by  the  addition  of  a small  quan- 
tity of  alcohol,  with  sugar  and  aromatics. 

OFFICIAL  PREPARATIONS  OF  MANGANESE. 

The  official  preparations  of  manganese  are  lim- 
ited in  number,  and,  as  suggested  above,  are  even 
more  limited  in  their  practical  application  as 
tonics  or  hematinics;  they  are: 


HEM  AT  IN  ICS. 


89 


MaNGANI  DlOXIDUAI  PRiECIPITATUM. — U.  S. — 
Precipitated  Manganese  Dioxid  is  a new  prepara- 
tion that  has  been  added  to  replace  the  formerly 
applied  crude  product.  Manganese  dioxid,  as  now 
official,  is  directed  to  be  made  from  manganese 
sulphate  and  should  contain  not  less  than  80  per 
cent,  of  manganese  dioxid. 

Average  dose:  0.25  gm.  (4  grains). 

Mangani  Sulphas. — IJ.  S. — This  occurs  as 
colorless  or  pale  pink  crystals  that  are  soluble  in 
less  than  one  part  of  water,  but  insoluble  in 
alcohol. 

Average  dose:  0.25  gm.  (4  grains). 

Potassii  PermangAnas.— -TT.  S. — This  sub- 
stance has  been  mentioned  in  the  chapters  on  dis- 
infectants and  antiseptics.  In  connection  with 
tonics  or  hematinics  it  is  of  interest  only  as  the 
source  of  some  of  the  now  popular  organic  prepara- 
tions of  manganese. 

ARSENIC. 

It  is  not  positively  known  whether  arsenic  is  an 
essential  constituent  of  the  human  body  or  not. 

Segale,  using  penici Ilium  brevicaule,  with  which 
infinitesimal  quantities  of  arsenic  may  he  detected, 
found  it  widely  distributed  in  animal  tissues,  and 
Bertrand  found  it  in  eggs,  particularly  in  the  yolk. 

Wieser  concluded  that  arsenic  is  not  a constant 
constituent  in  animal  and  human  tissues,  but  that 
it  is  accidentally  present. 

When  one  considers  the  distribution  of  arsenic 
in  plants,  in  sea  water  and  in  many  springs,  it  is 
apparent  that  abundant  opportunity  occurs  for  its 
entrance  into  the  body,  and,  owing  to  its  slow  ex- 
cretion, the  organism  may  rarely  be  without  traces 
of  it. 


90 


PHARMACOPEIA  AND  PHYSICIAN. 


If  minute  traces  of  arsenic  are  essential  to  the 
well-being  of  the  body  we  may  be  sure  that  the 
ordinary  food  insures  an  abundant  supply. 

Gies  found  that  those  members  of  a litter  of 
rabbits  which  received  arsenic  grew  faster  than  the 
others,  while  female  rabbits  under  its  influence 
bore  larger  young.  This  increased  rapidity  of 
growth  has  been  observed  by  some,  but  not  all,  sub- 
sequent investigators.  In  this  connection  the  ob- 
servation of  arsenic  in  the  yolk  of  egg  is  at  least 
suggestive. 

The  toxicology  of  arsenic  is  of  peculiar  interest 
because  of  its  frequent  use  with  fatal  effect  and 
because  the  appearance  of  the  earliest  symptoms 
are  used  as  a guide  in  the  therapeutic  use  of  the 
.substance. 

The  most  striking  effect  of  acute  arsenical 
poisoning  is  seen  in  the  symptoms  closely  re- 
sembling those  of  Asiatic  cholera,  and  which  are 
explainable  by  the  characteristic  action  on  the 
capillaries,  particularly  those  of  the  abdominal 
region. 

The  capillaries  appear  to  suffer  a peculiar  par- 
alysis and  dilation,  resulting  in  an  enormous  in- 
crease in  permeability.  The  escaping  plasma  of 
the  blood  makes  its  way  into  the  intestine  and, 
coagulating,  gives  rise  to  the  “rice-water'’  stools. 
The  withdrawal  of  the  blood  from  the  rest  of  the 
body  into  this  region  and  its  loss,  as  mentioned, 
causes  the  usual  symptoms  of  collapse. 

The  direct  effects  on  the  heart  are  too  slight  in 
such  cases  to  be  considered  as  important,  and  the 
corrosive  action  of  arsenic  is  too  slowly  developed 
to  be  concerned  in  the  immediate  effects  just  de- 
scribed, which  rapidly  follow  the  absorption  of  a 


HEMATINICS. 


91 


poisonous  dose.  When  the  poisoning  is  more  slow- 
ly developed,  however,  as  after  frequently  repeated 
smaller  doses,  catarrh  of  the  gastrointestinal  tract 
is  seen  and  fatty  degeneration  of  various  organs 
takes  place,  the  picture  somewhat  resembling  that 
seen  after  phosphorus  poisoning. 

Even  therapeutic  doses  frequently  repeated  give 
rise  to  effusion  of  liquid,  commonly  noticeable  in 
the  swollen  eyelids. 

Arsenic  is  said  to  be  capable  of  increasing  the 
number  of  erythrocytes  in  anemia  through  its 
action  on  the  bone  marrow,  but  Engel  found  no  in- 
crease in  the  mature  red  blood  cells  in  anemia; 
other  observers  failed  to  see  any  change  in  the  red 
blood  cells  or  in  the  hemoglobin,  though  it  is  ac- 
knowledged that  the  bone  marrow  is  stimulated  to 
unusual  activity. 

It  has  been  claimed  that  arsenic  actually  dimin- 
ishes the  number  of  red  blood  cells  in  chlorosis 
without  altering  the  total  amount  of  hemoglobin. 

It  has  been  suggested  that  the  influence  of  ar- 
senic on  metabolism  is  due  to  alternate  reduction 
and  oxidation,  arsenous  and  arsenic  acids  being  re- 
peatedly formed,  but  this  seems  hardly  probable. 

OFFICIAL  PREPARATION S OF  ARSENIC. 

Arseni  Trioxidum.  — U.  S.  — Arsenic  Trioxid 
was  formerly  official  as  Aeidum  Arsenosum.  It 
consists  of  not  less  than  99.8  per  cent,  of  pure 
arsenic  trioxid.  It  may  occur  in  transparent 
masses,  like  glass  or  in  opaque  masses  resembling 
porcelain;  more  frequently,  however,  it  is  found 
as  an  odorless  and  tasteless  white  powder  that  is 
slowly  but  completely  soluble  in  100  parts  of  water 
but  very  sparingly  soluble  in  alcohol.  The  pres- 


92 


PHARMACOPEIA  AND  PHYSICIAN. 


ence  of  either  alkalies  or  halogen  acids  facilitates 
the  solution  of  arsenic  trioxid,  and  this  fact  is 
taken  advantage  of  in  the  preparation  of  the  sev- 
eral official  solutions.  White  arsenic,  as  it  is  still 
called,  was  not  known  in  Europe  until  some  time 
after  the  eleventh  century.  It  was  scarcely  well 
defined  until  1733,  when  Brandt  accurately  deter- 
mined its  nature  and  leading  chemical  properties. 

Average  dose':  0.002  gm.  (2  mg.  or  1/30  grain). 

Arseni  Iodidum. — U.  S. — Arsenous  Iodid  oc- 
curs as  an  orange  red,  inodorous  crystalline  pow- 
der. It  is  soluble  with  partial  decomposition,  in 
about  12  parts  of  water  and  in  about  28  parts  of 
alcohol. 

Average  dose:  0.005  gm.  (5  mg.  or  1/10  grain). 

Sodii  Arsenas. — IT.  S. — This  occurs  as  color- 
less, transparent  odorless  prisms  that  are  soluble 
in  less  than  two  parts  of  water,  but  very  sparingly 
soluble  in  alcohol. 

Average  dose:  0.005  gm.  (5  mg.  or  1/10  grain). 

Sodii  Arsenas  Exsiccatus. — IT.  S. — This 

should  contain  not  less  than  98  per  cent,  of  pure 
anhydrous  di-sodium-ortho-arsenate.  It  occurs  as 
an  amorphous  white  powder,  permanent  in  dry 
air ; it  is  soluble  in  about  three  parts  of  water  and 
is  practically  double  the  strength  of  the  hydrous 
or  crystalline  preparation  mentioned  above. 

Average  dose:  0.003  gm.  (3  mg.  or  1/20  grain). 

SOLUTIONS  OF  ARSENIC. 

While  several  of  the  preparations  of  arsenic  ap- 
pear to  have  been  used  from  time  immemorial  as 
topical  applications,  the  internal  use  of  arsenic,  in 
Europe,  appears  to  date  from  the  introduction  of 
the  solution  of  potassium  arsenite,  popularly 


HEMATINICS. 


93 


known  as  Fowler’s  solution,  about  1786.  During 
the  following  decades  a number  of  modifications  of 
this  solution  of  arsenic  were  suggested  by  medical 
practitioners  and  apothecaries,  all  of  which  had, 
or  were  supposed  to  have,  some  distinctive  proper- 
ties. Of  these  almost  innumerable  solutions  that 
have  been  proposed  during  the  past  century,  the 
following  are  now  official : 

Liquor  Potassii  Arsenitis. — U.  S.— The  Solu- 
tion of  Potassium  Arsenite,  universally  known  as 
Fowler’s  solution,  as  noted  above,  was  the  first  of 
the  several  solutions  to  be  used  and  is  even  now 
the  most  popular,  being  known  in  every  civilized 
country  in  the  world. 

Solution  of  potassium  arsenite  contains  the 
equivalent  of  1 per  cent,  of  arsenic  trioxid,  with  a 
sufficient  amount  of  the  compound  tincture  of 
lavender  to  give  the  preparation  a distinctive  color 
and  flavor. 

Average  dose:  0.2  c.c.  (3  minims). 

Liquor  Acidi  Arsenosi. — IT.  S. — This  Solu- 
tion of  Arsenous  Acid  contains  the  equivalent  of  1 
per  cent,  of  arsenic  trioxid,  with  5 per  cent,  of 
diluted  hydrochloric  acid.  This  preparation  was 
introduced  about  the  end  of  the  eighteenth  cen- 
tury by  Dr.  De  Yalanquin,  in  London  ; it  was  the 
first  of  the  several  acid  preparations  of  arsenic. 

Average  dose:  0.2  c.c.  (3  minims). 

Liquor  Arseni  et  EEydrargyri  Iodidi. — TJ.  S. 
— This  preparation,  more  popularly  known  as 
Donovan’s  solution,  contains  1 per  cent,  each  of 
arsenous  iodid  and  mercuric  iodid. 

Average  dose:  0.1  c.c.  (l1/^  minims). 

Liquor  Sodii  Arsen atis. — IT.  S. — This  Solu- 
tion of  Sodium  Arsenate,  also  known  as  Pearson’s 


94 


PHARMACOPEIA  AND  PHYSICIAN. 


solution,  contains  1 per  cent,  of  exsiccated  sodium 
arsenate. 

Average  dose:  0.2  c.c.  (3  minims). 

THERAPEUTICS  OP  ARSENIC. 

While  the  probability  of  favorably  influencing 
nutrition  under  certain  conditions,  by  means  of 
the  action  of  arsenic  on  the  capillaries  can  not  be 
doubted,  its  therapeutic  use  for  such  purposes  is 
empirical.  The  use  of  arsenic  as  a local  caustic  has 
a rational  basis,  but  that  -will  not  be  discussed 
here. 

Arsenic  has  long  been  used  in  the  treatment  of 
a great  variety  of  complaints  in  which  anemia  is 
a prominent  symptom.  Among  these  conditions 
is  remittent  fever,  in  which  it  is  given  in  connec- 
tion with  quinin.  It  is  preferable  to  give  the  two 
separately,  arsenic  being  used  in  the  form  of  the 
solution  of  potassium  arsenite,  which  has  a wide 
range  of  pharmaceutic  incompatibility,  being  vir- 
tually an  alkaline  solution.  This  solution  may  be 
given  in  large  doses — ten  drops — gradually  re- 
duced, or  in  small  doses  rapidly  increased  until  in- 
testinal symptoms  or  swelling  of  the  eyelids  is 
seen,  after  which  the  drug  is  to  be  discontinued  for 
a time,  and  then  given  in  doses  of  from  three  to 
five  drops  three  times  a day.  It  is  of  importance 
that  the  dosage  be  watched  so  that  no  serious  dis- 
turbance of  digestion  may  occur.  The  frequently 
made  suggestion  to  combine  preparations  of  opium 
with  the  preparation  of  arsenic,  so  as  to  establish 
a tolerance  for  the  latter,  is  one  that  is  of  doubt- 
ful utility  in  view  of  the  fact  that  opium  would 
be  likely  to  mask  the  symptoms  that  occur  as  fore- 
runners of  more  serious  disturbances. 


HEMATINICS. 


95 


In  chlorosis,  arsenic  seems  to  be  useful  in  con- 
nection with  iron.  The  combination  most  fre- 
quently prescribed  is  a pill  of  ferrous  carbonate 
with  arsenic  trioxid.  For  this  purpose  the  latter 
may  be  combined  with  the  official  pill,  or  the  mass 
of  ferrous  carbonate,  as  follows : 


IJ.  Mass®  ferri  carbonatis . 3i  4| 

Arseni  trioxidi  gr.  i 1 05 


M.  et  div.  in  pil  No.  xl. 

Sig. : One  pill  three  or  four  times  a day. 

Pernicious  anemia  may  show  some  temporary 
improvement  under  arsenical  treatment,  but  the 
effect  is  not  permanent. 

It  has  been  said  that  lymphosarcoma  has  shown 
improvement  under  its  use,  and  the  following  con- 
ditions are  enumerated  among  those  in  which  it 
has  been  employed:  Dyspepsia,  diseases  of  the 

skin  dependent  on  nutritional  derangements, 
cachetic  conditions  resulting  from  diabetes,  tuber- 
culosis and  a number  of  other  more  or  less  well- 
defined  diseases. 

The  use  of  arsenic  among  veterinary  surgeons 
for  improving  the  appearance  of  horses  by  in- 
creasing the  glossiness  of  the  hair  and  adding  to 
the  fat  under  the  skin  is  well  known. 

PHOSPHORUS. 

Phosphorus,  in  both  inorganic  and  organic  com- 
bination, is  widely  distributed  in  the  body.  Leci- 
ithin,  a compound  of  cholin  with  phosphoric  and 
fatty  acids,  occurs  in  nearly  all  living  animal  and 
vegetable  tissues,  while  the  nucleins,  which  are 
also  rich  in  phosphorus,  are  likewise  widely  dis- 
tributed. 

While  some  observers  have  found  that  when 
lecithin  or  nuclein  was  added  to  the  food  of  ani- 


96 


PHARMACOPEIA  AND  PHYSICIAN. 


mals  the  latter  grew  faster  than  the  controls  which 
were  not  given  these  compounds,  these  results  are 
not  universally  accepted  as  proving  their  value, 
and  we  have  the  classic  research  of  Miescher, 
which  proves  that  the  animal  organism  is  abun- 
dantly able  to  form  those  compounds  from  others 
normally  existing  in  the  body. 

Midscher  found  that  the  mass  of  eggs  in  the 
salmon  increased  from  0.4  per  cent,  to  from  19  to 
27  per  cent,  of  the  total  body  weight  during  some 
months  when  the  salmon  took  no  food,  while  the 
muscles  showed  a corresponding  loss  in  weight. 
Much  more  nuclein  and  lecithin  are  found  in  the 
eggs  than  previously  existed  in  the  muscle,  which, 
however,  are  rich  in  other  phosphoric-acid  com- 
pounds, probably  potassium  salts  which  are  loosely 
bound  to  the  proteid. 

Miescher  concludes,  and  the  evidence  seems  in- 
controvertible, that  the  newly  formed  combinations 
characteristic  of  the  egg  (including  lecithin  and 
nuclein)  are  formed  by  chemic  action  from  the 
albumin,  fat  and  phosphates  of  the  muscle. 

It  will  be  readily  seen  how  the  makers  of  nos- 
strums  can  use  such  results  as  those  quoted  in  re- 
gard to  the  action  of  lecithin  in  causing  an  in- 
crease in  the  body  weight,  while  the  much  more 
important  and  generally  accepted  results  of  Mies- 
eher  are  ignored. 

Phosphorus  and  its  preparations  might  be  omit- 
ted without  serious  detriment  to  this  chapter,  but 
for  the  fact  that  they  have  been  so  widely  used 
and  therefore  require  at  least  a passing  notice, 
particularly  as  the  toxicology  of  phosphorus  is  of 
considerable  interest. 


HEMATINIGS. 


97 


The  heart  suffers  greater  direct  injury  in  phos- 
phorus poisoning  than  does  any  other  organ,  while 
the  accumulation  of  fat  which  it  causes  in  the  liver 
is  apparently  an  infiltration,  resulting  from  a 
peculiar  disturbance  of  metabolism  rather  than  the 
result  of  any  change  in  the  organ  itself. 

Hemorrhages  may  occur  from  degeneration  of 
the  capillary  walls,  while  a similar  effect  on  the 
mucous  membranes  of  the  stomach  and  intestine 
causes  pain,  vomiting  and  diarrhea. 

Minute  doses  of  phosphorus,  long  continued,  in- 
duce a peculiar  change  in  the  growth  of  the  bones 
in  the  young,  leading  to  the  deposition  of  dense 
bone  where  cancellous  is  being  formed,  or  the 
change  of  the  latter,  when  already  formed,  into  the 
compact  form. 

The  phosphates  are  of  the  very  greatest  im- 
portance in  the  plant  and  animal  bodies,  but  they 
occur  so  abundantly  in  the  soil  and  in  ordinary 
food  that  there  is  seldom  any  deficiency  in  the  sup- 
ply, and  any  want  of  them  in  the  human  body 
must  be  due  to  the  inability  to  use  that  which  is 
offered.  Schmiedeberg  calls  attention  to  the  for- 
mation of  the  egg  shell  as  evidence  of  the  great 
capacity  of  the  animal  organism  to  supply  a special 
demand. 

Sollmann  states  that  there  is  absolutely  no 
scientific  foundation  for  the  popular  belief  that 
the  hypophosphites  improve  nutrition  in  anemia 
and  beginning  phthisis,  while  Cushny  states  that 
most  reliable  investigators  deny  that  they  have  any 
other  influence  on  nutrition  and  digestion  than 
that  of  the  better  known  and  cheaper  salts  of  lime. 


98 


PHARMACOPEIA  AND  PHYSICIAN. 


soda  or  iron,  and  Schmeideberg  appears  to  think 
them  entirely  unworthy  of  notice. 

Many  clinicians,  on  the  other  hand,  appear  to 
have  observed  a distinct  improvement  in  the  appe- 
tite and  digestion  under  the  influence  of  the  hypo- 
phosphites,  but  even  if  such  is  the  case,  there 
seems  to  be  absolutely  no  reason  or  excuse  for  our 
employing  such  a high-priced,  unsightly  and  un- 
scientific preparation  as  the  muddy-looking  Fel- 
low’s syrup,  since  any  competent  pharmacist  can 
make  a more  presentable  and  more  satisfactory 
preparation  at  a very  much  smaller  cost.  In  fact, 
if  the  hypophosphites  do  possess  any  distinct  me- 
dicinal properties,  the  official  preparations  afford 
an  ample  choice  for  any  condition  or  need. 

OFFICIAL  PREPARATIONS  OF  PHOSPHORUS. 

Phosphorus. — TJ.  S. — A translucent,  nearly 
colorless  solid,  having  at  ordinary  temperatures 
about  the  consistency  of  beeswax. 

Phosphorus  is  nearly  insoluble  in  water,  but  is 
soluble  in  350  parts  of  alcohol  and  in  50  parts  of  a 
fatty  oil. 

Average  dose:  0.0005  gm.  (0.5  mg.  1/128 

grain) . 

Pilulh?  Pilosphori. — U.  S. — Each  pill  con- 
tains 0.0006  gm.  (0.6  mg.  1/100  grain). 

Average  dose:  1 pill 

Acidum  Phosphoricum. — U.  S. — This  con- 
tains 85  per  cent,  of  absolute  orthophosphoric  acid. 
It  is  usually  prescribed  as : 

Acidum  Phosphoric  Dilutum. — U.  S. — This 
contains  10  per  cent,  of  absolute  orthophosphoric 
acid. 


HEMATINICS. 


99 


Average  dose:  2 c.c.  (30  minims). 

Phosphoric  acid  has  many  of  the  properties  of 
other  (inorganic)  acids,  and  probably  has  no  evi- 
dent advantage  over  them  as  a tonic. 

The  official  salts  of  phosphoric  acid  usually  par- 
take of  the  properties  of  the  base  rather  than  the 
acid,  and  need  not  be  mentioned  in  this  connection. 

Acidum  Hypophosphorosum. — U.  S. — This 
contains  30  per  cent,  of  absolute  hypophosphorous 
acid  and  is  chiefly  used  in  preparing : 

Acidum  Hypophosphorosum  Dilutum.  — IT. 
S.- — This  contains  10  per  cent,  of  absolute  hypo- 
phosphorous  acid. 

Average  dose:  0.5  c.c.  (8  minims). 

The  official  salts  of  hypophosphorous  acid  are : 

Calcii  Hypophosphis. — IT.  S. 

Potassii  Hypophosphis. — IT.  S. 

Sodii  Hypophosphis. — IT.  S. 

Average  dose  of  any  one  of  the  above : 0.50  gm. 
(T1/)  grains). 

Potasium  hypophosphite  is  soluble -in  about  0.5 
part  of  water  and  in  25  parts  of  alcohol,  and  cal- 
cium hypophosphite  is  soluble  in  about  7 parts  of 
water,  but  is  almost  insoluble  in  alcohol. 

In  addition  to  the  alkali  hypophosphites,  we  also 
have  official : 

Ferri  Hypophosphis. — IT.  S. — and: 

Mangani  Hypophosphis. — IT.  S. 

Average  dose  of  either:  0.20  gm.  (3  grains). 

The  ferric  hypophosphite  is  soluble  in  2,300 
parts  of  water,  but  is  much  more  readily  soluble  in 
solutions  of  hypophosphorous  acid  and  the  alkali 
citrates.  Manganese  hypophosphite  is  soluble  in 
about  7 parts  of  water. 

Syrupus  Hypophosphitum. — II  S. — Syrup  of 


100 


PHARMACOPEIA  AND  PHYSICIAN. 


hypophosphites  contains  In  100  c.c.  4.5  gm.  of  cal- 
cium hypophosphite  and  1.5  gm.  each  of  sodium 
and  of  potassium  hypophosphites. 

Average  dose:  8 c.c.  (2  fluidrachms). 

Syrupus  Hypophosphitum  Compositus. — U. 
S. — Compound  Syrup  of  Hypophosphites  contains, 
in  each  average  dose  (8  c.c.  = 2 fluidrams)  about 
0.25  gm.  (4  grains)  of  calcium  hypophosphite, 
0.12  gm.  (2  grains)  each  of  potasium  hypophos- 
phite and  of  sodium  hypophosphite,  0.015  gm.  (% 
grain)  each  of  ferric  hypophosphite  and  of  man- 
ganese hypophosphite,  0.008  gm.  (%  grain)  of 
quinin,  0.0008  gm.  (1/80  grain)  of  strychnin  with 
sodium  citrate,  hypophosphorous  acid  and  syrup. 

Average  dose:  8 c.c.  (2  fluidrams). 

Syrupus  Calcii  Lactophosphatis. — IJ.  S. — 
This  syrup  contains  in  100  c.c.  about  3 gm.  of  cal- 
cium lactophosphate  with  free  lactic  . and  phos- 
phoric acids. 

Average  dose:  8 c.c.  (2  fluidrams). 

The  several  salts  of  glycerophosphoric  acid  which 
are  being  advertised  so  extensively  at  the  present 
time,  as  the  active  constituents  of  a number  of  nos- 
trums, are  as  yet  not  official.  It  is  quite  probable, 
however,  that  longer  experience  will  demonstrate 
that  they  have  absolutely  no  advantages  over  the 
hypophosphites  or  the  lactophosphates,  and  that 
their  widespread  use  at  present  is  but  a passing  fad. 

THERAPEUTICS  OE  PHOSPHORUS  AjStD  ITS  SALTS. 

There  is  at  least  a rational  basis  for  the  use  of 
phosphorus  in  rickets,  osteomalacia  and  fracture 
of  bones  in  which  union  fails  to  occur,  since  a dep- 
osition of  lime  salts  in  bone  has  been  shown  to  re- 
sult from  its  use. 


HEMATINICS. 


101 


It  must  not  be  given  in  doses  large  enough  to 
cause  serious  gastrointestinal  disturbance. 

When  we  say  that  phosphorus  or  the  hypophos- 
phites  are  used  empirically  in  the  following  con- 
ditions it  is  not  to  be  understood  that  we  recom- 
mend them,  but  merely  that  they  may  possibly  be 
worthy  of  a trial.  Thus  some  clinicians  have  used 
phosphorus  in  a variety  of  nervous  disorders,  and 
the  hypophosphites  are  very  often  used  as  general 
tonics.  The  treatment  of  tuberculosis  by  the 
hypophosphites  has  no  place  in  modern  therapeu- 
tics. 

Phosphorus  is  so  slightly  soluble  in  water  that  it 
was  often  dissolved  in  oil,  but  the  phosphorated  oil 
is  no  longer  official.  The  pills  of  phosphorus,  each 
containing  0.6  milligrams  (1/100  grain)  afford  a 
very  convenient  form  for  administration. 

The  compound  syrup  of  the  hypophosphites, 
with  its  eleven  ingredients,  including  water,  af- 
fords an  example  of  the  concessions  made,  by  the 
revision  committee  of  the  Pharmacopeia,  to  pop- 
ular prejudice,  and  in  time  to  come  it  will  no 
doubt  be  relegated  to  its  proper  resting  place  with 
other  polypharmacal  preparations  of  the  centuries 
long  passed. 

The  claim  has  been  made  that  the  hypophos- 
phites are  effective  only  when  the  chemically  pure 
salts  are  used;  this  claim,  however,  seems  scarcely 
credible  in  view  of  the  fact  that  our  ordinary  food 
contains  much  greater  quantities  of  just  such  salts 
as  are  said  to  render  the  hypophosphites  useless. 

From  one  to  two  teaspoonfuls  of  the  compound 
syrup  of  the  hypophosphites  may  be  given  before 
meals,  as  a stimulant  to  the  appetite  and  diges- 
tion. Acids  and  acid  fruits  are  to  be  avoided. 


102  PHARMACOPEIA  AND  PHYSICIAN. 

The  following  may  be  taken  as  a type  formula 
for  an  extemporaneous  preparation  of  the  hypo- 
phosphites  : 


It.  Calcii  hypophosphis 
Sodii  hypophosphis 

Potassii  hypophosphis,  aa 3i  4| 

Aeidi  hyphosphor  3i  4| 

Aqua;  dest §iv  120  [ 

Elixir  q.  s.  ad gviii  250  j 


M.  et  filtra.  Sig. : One  or  two  teaspoonfuls  three  times 

a day,  before  eating. 

The  elixir  in  this  preparation  may  be  replaced 
by  glycerin,  or  an  aromatic  water,  the  combina- 
tion of  the  hypophosphites  may  be  varied,  within 
reasonable  limits,  and  the  hypophosphorous  acid 
substituted  by  citric  acid  or  by  an  alkali  citrate. 
When  desirable  sufficient  bitter  may  be  added  to 
make  the  medicine  more  palatable  or  to  act  as  a 
bitter  tonic.  For  this  purpose  the  tincture  of  nux 
vomica,  or  one  of  the  bitter  alkaloids,  may  be 
added. 

COD-LIVER  OIL. 

The  consideration  of  cod-liver  oil  rightly  be- 
longs under  the  subject  of  dietetics,  as  nearly  all 
pharmacologists  are  agreed  that  it  is  merely  a 
food,  but  it  is  so  frequently  lauded  as  a medicine 
that  some  mention  of  it  is  necessary  in  this  place. 

On  the  discovery  of  traces  of  certain  alkaloids  or 
ptomains  it  was  suggested  that  they  possessed  ex- 
traordinary value,  but,  as  these  substances  are 
usually  present  in  infinitesimally  small  quantities 
in  good  oil,  and  as  there  is  no  reason  to  suppose 
that  they  possess  any  beneficial  effect  whatsoever, 
it  can  not  be  said  that  the  so-called  fat  free  or 
tasteless  cod-liver  oils  can  in  any  sense  of  the  word, 
represent  cod-liver  oil. 


HEMATINICS. 


103 


The  crude  dark-colored  oil  often  contains  a 
much  larger  proportion  of  free  fatty  acids  than 
the  white  does,  and  it  should,  therefore,  be  more 
readily  emulsified  in  the  intestine  and  absorbed, 
but  its  disagreeable  odor  and  taste  render  it  pe- 
culiarly disgusting  to  all  patients  with  delicate 
stomachs.  Small  doses  of  cod-liver  oil  can  usually 
be  borne,  especially  if  it  be  given  in  the  form  of 
an  emulsion,  but  even  this  is  not  always  tolerated. 

OFFICIAL  PREPARATIONS  OF  COD  LIVER  OIL. 

Oleum  Morrhujs. — U.  S. — This  preparation  is 
official  in  some  of  the  foreign  pharmacopeias  as 
Oleum  Jecoris  Aselli,  a name  that  may  be  useful 
on  occasion.  Cod-liver  oil  is  a fixed  oil  obtained 
from  the  fresh  livers  of  Gadus  morrhuoe  and  of 
other  species  of  Gadus. 

Average  dose : 15  c.c.  (4  fluidrams) . 

Emulsum  Olei  Morriiuje. — IT.  S. — The  Emul- 
sion of  Cod-liver  Oil  contains  50  per  cent,  of  the 
oil,  with  mucilage  and  syrup,  and  is  flavored  with 
oil  of  gaultheria. 

Average  dose:  8 c.c.  (2  fluidrams). 

Emulsum  Olei  Morrhuoe  cum  Hypophos- 
phitibus. — IT.  S. — This  contains  50  per  cent,  of 
cod  liver  oil,  1 per  cent,  of  calcium  hypophosphite, 
and  0.5  per  cent,  each  of  potassium  hypophosphite 
and  of  sodium  hypophosphite.  It  is  flavored  with 
oil  of  gaultheria. 

Average  dose:  8 c.c.  (2  fluidrams). 

Ccd-liver  oil  is  often  useful  in  anemias  due  to 
faulty  nutrition  and  in  the  general  debility  which 
so  often  precedes  tuberculosis:  For  this  reason, 

perhaps,  it  has  acquired  a particular  reputation  in 
the  treatment  of  tuberculosis.  It  can  have  no 


104 


PHARMACOPEIA  AND  PHYSICIAN. 


specific  action  on  the  bacillus  of  tuberculosis,  nor 
on  the  course  of  the  disease,  except  in  so  far  as  it 
is  a readily  assimilable  food. 

It  is  often  found  to  be  useful  in  rickets.  The 
pure  oil,  the  emulsion,  or  the  emulsion  with  hypo- 
phosphites  may  be  used,  the  dose  to  be  regulated 
according  to  the  capacity  for  assimilation  of  the 
individual  case. 

It  may  be  added  here  that  the  petroleum  oils 
alone,  or  in  the  form  of  emulsions,  are  wholly  de- 
void of  nutrient  properties.  They  are  mineral  oils, 
and,  therefore,  non-saponifiable  and  can  take  no 
part  in  animal  nutrition. 

ALTERATIVES. 

Alteratives  are  tonics,  which,  in  some  unknown 
way,  favorably  influence  the  processes  of  nutri- 
tion which  have  been  disturbed  by  disease.  They 
include  hematinics,  the  various  preparations  of 
mercury,  and  many,  if  not  all  the  preparations  con- 
taining iodin,  either  free  or  in  combination. 

A number  of  drugs  of  vegetable  origin,  such  as 
sarsaparilla,  were  formerly  classed  as  alteratives, 
but  these  are,  for  the  most  part,  merely  purgatives, 
or  else  devoid  of  therapeutic  interest. 

The  use  of  the  thyroid  gland  in  thyroid  disease 
and  in  obesity,  and  of  the  newly  discovered  serum 
of  Beebe  in  exophthalmic  goiter,  have  a scientific 
basic,  but  the  employment  of  iodids  in  rheumatism 
and  in  syphilis,  and  of  the  mercurials  in  the  latter 
disease  is  empirical,  and  in  this  connection  the 
pharmacology  of  these  agents  is  of  minor  import- 
ance since  it  throws  little  light  on  their  therapeu- 
tic applications. 

While  the  attempts  to  investigate  the  action  of 


ALTERATIVES. 


105 


these  agents  have  not  led  to  satisfactory  results, 
we  may  refer  to  the  conclusions  of  J.  Levi,  who 
sought  to  compare  the  effect  of  mercurials  and  of 
potassium  iodid  on  the  metabolism  and  on  the 
blood  of  syphilitics.  He  used  potassium  iodid  and 
various  organic  and  inorganic  preparations  of 
mercury  in  the  second  stage  of  the  disease  in  252 
patients. 

Levi  found  that  mercurials  increase  organic 
combustion  and  hasten  metabolism  in  this  condi- 
tion. With  the  gradual  disappearance  of  the  dis- 
ease the  processes  of  nutrition  improve,  but  re- 
lapses are  frequent.  He  found  no  evidence,  how- 
ever, of  a specific  influence  on  the  micro-organism 
of  syphilis,  but  according  to  the  most  recent  view 
mercury  is  antagonistic  to  this  micro-organism. 

If  the  use  of  mercurials  be  too  greatly  pro- 
longed the  number  of  red  blood  corpuscles  is 
diminished.  Levi  found  that  potassium  iodid  had 
a similar  general  influence  on  the  nutrition  of 
syphilitics.  While  it  causes  an  increase  in  the 
body  weight,  improves  the  blood,  and  adds  to  the 
muscular  strength,  it  retards  combustion  and  less- 
ens metabolism.  He  explains  its  uses  in  tertiary 
syphilis  by  supposing  that  it  neutralizes  the  dis- 
ease products  without  increasing  organic  combus- 
tion. 

Nearly  all  observers  are  agreed  that  the  action  of 
mercurials  is  almost  wholly  independent  of  the 
preparation  chosen,  the  only  essential  for  its  ac- 
tion being  that  it  shall  be  absorbed.  Mercury 
probably  circulates  as  an  albuminate,  which  is  sol- 
uble in  the  blood  because  of  the  excess  of  proteids 
and  chlorids  which  it  encounters  there. 

Owing  to  the  obscurity  of  many  of  the  symp- 


106 


PHARMACOPEIA  AND  PHYSICIAN. 


toms  of  syphilis,  and  also  to  the  fact  that  a com- 
paratively large  number  of  people  are  not  -willing 
to  have  it  known  to  their  physician  that  they  suf- 
fer with  so  loathsome  a disease,  the  condition  is 
peculiarly  favorable  for  the  practice  of  charla- 
tans. While  there  is  no  disease  that  more  ur- 
gently demands  the  skill  and  judgment  of  the 
specialist,  there  is  none,  perhaps,  that  is  so  fre- 
quently treated  by  incompetents  and  even  by 
patients  themselves. 

While  we  have  always  with  us  the  humiliating 
spectacle  of  numerous  nostrums  ostensibly  adver- 
tised only  to  the  medical  profession,  some  of  them 
of  vegetable  origin  and  wholly  worthless  in  syph- 
ilis, others  consisting  of  one  form  or  another  of 
mercury  and  possessing  few  or  no  advantages  over 
the  old  and  better  known  official  mercurials,  we 
are  also  daily  confronted  with  advertisements 
which  disgrace  our  boasted  civilization  in  that  they 
seek  to  persuade  the  deluded  victims  to  palter  with 
the  useless  nostrums  in  the  vain  effort  to  treat 
themselves. 

MERCURY  AND  THE  MERCURIALS. 

Hydrargyrum. — IT.  S. — Mercury,  or  quick  sil- 
ver, has  been  known  from  remote  antiquity,  and 
from  the  earliest  times  has  played  an  important 
part,  not  alone  in  the  industries,  arts  and  supersti- 
tions, but  also  in  the  medical  practices  of  the  peo- 
ple who  were  acquainted  with  it. 

Even  at  present,  this  substance,  in  the  form  of 
preparations  produced  by  mechanical  subdivision 
of  the  mercury,  is  widely  used  for  external  appli- 
cation as  well  as  for  internal  administration.  Sev- 
eral of  the  preparations  of  mercury  have  been  men- 


ALTERATIVES. 


107 


tioned  under  other  headings,  and  we  shall  content 
ourselves,  therefore,  with  recounting  a few  of  the 
salient  features  of  these  several  substances. 

Hydrargyrum  cum  Creta. — IT.  S. — Mercury 
with  Chalk,  also  known  as  gray  powder,  represents 
38  per  cent,  of  metallic  mercury,  with  clarified 
honey  and  prepared  chalk. 

Average  dose:  0.25  gm.  (4  grains). 

Massa  Hydrargyri. — IT.  S. — Mass  of  Mercury, 
better  known  as  blue  mass,  contains  33  per  cent, 
of  metallic  mercury,  with  glycyrrhiza,  althaea, 
glycerin  and  honey  of  roses.  An  analogous  prep- 
aration without  the  glycerin  is  frequently  found  in 
the  shops  under  the  somewhat  incongruous  title, 
“Powdered  Blue  Mass.” 

Average  dose:  0.25  gm.  (4  grains). 

The  mass  of  mercury  and  the  mercury  with 
chalk  are  widely  used  as  mild  mercurials  and  are 
especially  popular  for  use  with  children. 

Probably  the  most  widely  used  as  well  as  the 
most  popular  of  all  the  preparations  of  mercury  as 
an  antisyphilitic  is : 

Hydrargyri  Iodidum  Plavum.— U.  S. — Yel- 
low Mercurous  Iodid  occurs  as  a bright  yellow,  am- 
orphous powder,  without  odor  or  taste,  and  is 
practically  insoluble  in  water  and  in  alcohol. 

Average  dose:  0.01  gm.  (10  mg.  or  1/5  grain). 

Hydrargyri  Iodidum  Rubrum. — U.  S. — Red 
Mercuric  Iodid  occurs  as  a scarlet-red,  amorphous 
powder  that  is  nearly  insoluble  in  water,  but  sol- 
uble in  116  parts  of  alcohol;  it  is  also  soluble  in 
solutions  of  the  soluble  iodids  and  in  solution  of 
mercuric  chlorid. 

Average  dose:  0.003  gm.  (3  mg.  or  1/20  grain). 

Hydrargyri  Chloridum  Corrosivum. — U.  S. 


108 


PHARMACOPEIA  AND  PHYSICIAN. 


— Corrosive  Mercuric  Chlorid,  more  popularly 
known  as  corrosive  sublimate,  has  been  used  by  the 
Chinese  from  a very  early  period.  It  was  used  by 
the  early  Arabian  physicians,  and  a process  for 
its  production  was  described  by  Geber  in  _ the 
eighth  century. 

Mercuric  chlorid  occurs  as  colorless,  rhombic 
crystals  or  crystalline  masses,  or,  more  frequently, 
as  a white  powder,  and  is  odorless,  but  has  an 
acrid  and  persistent  metallic  taste.  It  is  soluble 
in  about  thirteen  parts  of  water  and  in  five  parts 
of  alcohol,  more  freely  soluble  in  solutions  of  the 
alkaline  chlorids. 

Average  dose:  0.003  gm.  (3  mg.  or  1/20  grain). 

Hydrargyri  Chloridum  Mite. — U.  S. — Mild 
Mercurous  Chlorid,  better  known  as  calomel,  has 
been  known  to  some  of  the  Eastern  people 
from  a very  early  period.  It  appears  to  have 
been  introduced  in  Europe  about  the  beginning 
of  the  seventeenth  century.  This  substance  occurs 
as  a heavy  white  powder,  without  odor  and  prac- 
tically without  taste,  and  is  insoluble  in  water  and 
in  alcohol. 

Average  dose  as  an  alterative:  0.05  gm.  (1 
grain) . 

The  Pharmacopeia  includes  several  additional 
compounds  of  mercury,  but  as  they  are  not  used 
for  internal  administration  they  need  not  be  enu- 
merated in  this  connection. 

USES  OF  MERCURIALS. 

Since  the  use  of  mercury  as  an  alterative  is 
largely  limited  to  those  conditions  resulting  from 
syphilis,  either  acquired  or  congenital,  we  shall  at 


ALTERATIVES. 


109 


present  confine  ourselves  to  discussing  its  employ- 
ment in  this  way. 

The  pathology  of  syphilis  is  very  often  so  ob- 
scure that  it  should  be  treated  by  the  specialist 
when  possible,  and  the  following  is  intended  for 
the  general  practitioner  who  finds  himself  com- 
pelled to  undertake  the  treatment  of  such  cases. 

There  are  many  distinct  symptoms  that  are  man- 
ifested by  patients  with  a syphilitic  history  which 
fail  to  respond  to  the  treatment  which  is  commonly 
successful  with  persons  otherwise  healthy,  but 
which  at  once  disappear  when  mercury  is  given. 

Many  authorities  are  opposed  to  any  form  of 
constitutional  treatment  for  the  first  stage  of 
syphilis  because  we  have  no  specific,  and  the  treat- 
ment may  mask  or  even  prevent  the  appearance  of 
those  symptoms  which  render  the  diagnosis  abso- 
lutely positive,  without  preventing  the  ultimate 
effects  of  the  disease,  thus  condemning  the  patient 
to  the  hardships  of  a long  and  painful  course  of 
treatment  without  positive  knowledge  of  its  neces- 
sity. Others  rely  on  their  ability  to  diagnose  syph- 
ilis by  the  chancre  and  the  history  of  the  case,  and 
proceed  at  once  to  the  use  of  mercury. 

Inasmuch  as  it  is  supposed  that  mercury  has 
comparatively  little  immediate  influence  on  the 
course  of  the  disease  at  this  time,  we  should  be 
very  sure  of  the  correctness  of  our  diagnosis  be- 
fore beginning  a course  of  treatment  which,  to  be 
effective,  must  be  continued  for  many  months,  and 
is  in  itself  not  free  from  danger  to  the  patient’s 
health. 

When  the  history  of  the  case,  together  with  the 
chancre,  renders  an  immediate  diagnosis  certain, 
treatment  should  be  instituted  at  once. 


110 


PHARMACOPEIA  AND  PHYSICIAN. 


All  mercurials  are  irritant  when  dissolved  and 
there  are  serious  objections  to  all  the  different 
available  methods  of  administration.  Chief  among 
these  objections  is  the  disturbance  of  digestion, 
which  is  not  wholly  obviated  even  when  the  mer- 
cury is  injected  hypodermically  or  applied  by  in- 
unction. 

Diarrhea  is  often  a troublesome  result,  for 
which  opium  is  advised,  but  the  evils  attending  its 
use  are  obvious  and  its  presence  should  always  be 
suspected  in  nostrums  containing  well-known 
mercurials  that  are  advertised  as  being  guaran- 
teed  not  to  cause  diarrhea  or  other  gastric  disturb- 
ances. Mercury  is  eliminated  by  all  the  channels 
of  excretion  and  the  kidneys  not  infrequently  suf- 
fer serious  injury.  It  follows  that  we  must  try  to 
find  the  method  best  suited  to  the  individual  case, 
and  attention  is  directed  to  the  following  means 
of  administration  with  some  of  the  objections  to  be 
guarded  against  or  at  least  kept  in  mind : 

It  is  generally  agreed  that  since  there  is  no  es- 
sential difference  between  the  action  of  the  various 
organic  and  inorganic  salts  of  mercury  in  syphilitic 
conditions,  we  should  be  guided  in  our  choice  of 
agent  by  the  method  of  administration  which  ex- 
perience teaches  us  to  he  best  suited  to  the  individ- 
ual case.  If  the  digestion  suffers  from  the  internal 
administration  of  mercurials,  intramuscular  injec- 
tion may  be  tried;  if  these  are  too  painful,  inunc- 
tion may  be  resorted  to ; hut  whatever  method  is 
followed  we  must  be  alert  for  the  appearance  of 
untoward  effects  and  the  diet  must  he  the  object 
of  especial  attention,  one  being  selected  which  is 
nutritious  while  it  is  easily  digested. 

The  mercurials  are  to  be  avoided  or  used  only 


ALTERATIVES. 


Ill 


with  great  caution  in  cachexia  due  to  other  causes 
than  syphilis,  as  their  tendency  to  disturb  diges- 
tion may  increase  the  trouble. 

They  must  be  used  only  with  the  greatest  cau- 
tion in  acute  nephritis,  but  they  seem  to  be  less 
deleterious  in  the  chronic  form,  though  here,  too, 
their  action  must  be  carefully  observed. 

Mercury  is  particularly  potent  for  harm  in 
pregnancy,  especially  in  the  latter  months;  abor- 
tion may  occur  or  the  child  may  suffer  from  mer- 
curial poisoning. 

For  internal  use  either  mercurous  or  mercuric 
iodid  is  usually  preferred.  The  combination  of 
mercuric  chlorid  with  potassium  iodid  merely 
means  the  giving  of  mercuric  and  potassium  iodids, 
as  the  reaction  occurs  as  soon  as  the  two  substances 
are  brought  into  contact.  When  the  mercuric 
chlorid  is  used  it  is  best  given  alone,  in  dilute  so- 
lution, as  it  is  incompatible  with  a great  many 
substances. 

Mercuric  chlorid  may  be  given  as  follows : 


R.  Hydrargyri  chloridi  eor gr.  iii  1 20 

Potassii  iodidi gr.  x 1 60 

Aquae  dest.,  q.  s.  ad f.*iii  100  [ 


M.  Sig. : Ten  drops  in  water  after  each  meal.  In- 

crease each  dose  daily  by  one  drop  until  symptoms  of 
mercurialism  are  noted,  then  reduce  to  one-half. 

This  is  not  given  as  an  example  of  the  so-called 
mixed  treatment,  the  dose  of  potassium  iodid  being 
entirely  too  small  to  be  effective. 

An  example  of  a prescription  for  mixed  treat- 
ment would  be  as  follows: 


R.  Hydrargyri  chloridi  cor gr.  i 1 60 

Potassii  iodidi  3ii  8| 

Aquae  dest.,  q.  s.  ad f.Siii  100 1 


M.  Sig. : One  teaspoonful  after  each  meal. 


112 


PHARMACOPEIA  AND  PHYSICIAN. 


The  object  of  giving  the  mercurials  after  meals 
is  to  insure  the  protection  of  the  stomach,  which 
the  presence  of  food  affords,  against  the  irritant 
action  of  the  metal. 

The  menstruum  or  diluent  for  the  prescription 
for  mixed  treatment  may  be  varied  in  a number  of 
ways.  The  water  may  be  substituted  by  any  one 
of  the  medicated  waters,  by  elixir  adjuvant,  aro- 
matic exilir,  compound  tincture  of  gentian,  com- 
pound syrup  of  sarsaparilla,  or  by  a mixture  of  one 
or  more  of  these  vehicles ; the  most  important 
point  to  be  guarded  against  is  the  attempt  to  com- 
bine the  potassium  and  mercuric  iodid  with  alka- 
loids in  solution,  as  the  mixture  of  potassium  and 
mercuric  iodids  is  one  of  the  most  effective  of  pre- 
cipitants  for  alkaloids. 

The  characteristic  effects  of  mercury  are  to  be 
carefully  watched  for  and  when  the  gums  become 
slightly  tender  the  dose  is  to  be  reduced  somewhat 
in  amount  and  given  but  twice  a day — after  the 
morning  and  evening  meals.  It  would  be  well  to 
wash  down  the  dose  with  milk,  the  proteid  of 
which  will  serve  to  protect  the  stomach  against 
the  irritant  action  of  the  mercury. 

Mercurous  iodid  is  not  so  corrosive  as  the  mer- 
curic, or  red  iodid.  and  it  is  often  given  in  pill 
form  with  some  colloidal  substance,  such  as  ex- 
tract of  gentian. 

The  following  is  an  example  of  this  method  of 
giving  it : 

R.  Hydrargyri  iodidi  flav gr.  vi  1 40 

Extracti  gentianse  gr-  lx  4| 

M.  Fiat  pilulae  No.  lx.  Sig. : One  pill  after  eating. 

This  dose  may  be  gradually  increased  by  giving 
two  pills  after  the  mid-dav  meal,  and  then  two 


ALTERATIVES. 


113 


twice,  and  finally  three  times  a day  until  the  symp- 
toms of  mercurialism  mentioned  above  are  seen. 
The  dose  is  then  reduced,  as  in  the  case  of  mer- 
curic iodid,  and  given  after  the  principal  meals. 

The  mild  mercurous  chlorid,  or  calomel,  may 
be  used,  but  it  is  so  insoluble  that  it  is  impossible 
to  regulate  the  amount  that  is  absorbed.  Next  to 
the  administration  of  mercurials  by  the  mouth,  the 
intramuscular  injection  is  to  be  preferred,  but  it 
causes  great  pain  and  may  result  in  abscess  unless 
caution  is  observed.  The  addition  of  cocain  hydro- 
chlorid  has  been  recommended  by  some  authori- 
ties, but  we  should  bear  in  mind  the  danger  of 
forming  a habit  which  is,  if  anything,  even  more 
terrible  than  syphilis. 

The  injection  should  be  made  by  the  physician, 
as  the  patient  can  not  be  trusted  to  do  it  satis- 
factorily. 

Eight  milligrams  (one-eighth  of  a grain)  of 
mercuric  chlorid,  or  of  the  unofficial  mercuric 
salicylate,5  is  dissolved  in  about  ten  minims  of 
normal  saline  solution  and  injected  deeply  into 
the  gluteal  muscle,  care  being  taken  to  avoid  the 
spot  which  supports  the  body  when  the  patient  is 
seated.  The  part  should  then  be  massaged  gently 
and  an  ice  bag  or  cold  compress  applied  to  relieve 
pain. 

The  injections  may  be  repeated  two  or  three 
times  a week.  The  inunction  method  is  very  com- 
monly employed  in  the  establishments  at  Hot 
Springs,  Ark.,  where  many  syphilitics  are  treated. 

The  inunction  may  be  done  as  follows : After 

5.  Six  grains  (0.4  gms.)  of  mercuric  chlorid  to  the  fluid 
ounce  (30  c.c.)  will  equal  % grain  (8  milligrams)  in  ten 
minims. 


114 


PHARMACOPEIA  AND  PHYSICIAN. 


inducing  diaphoresis,  3 grams  (about  45  grains) 
of  mercurial  ointment  are  rubbed  into  the  skin,  not 
on  it,  daily.  As  this  must  be  applied  to  a rather 
large  extent  of  surface  it  is  customary  to  select 
six  regions  which  are  utilized  on  successive  days, 
returning  on  the  seventh  day  to  the  first  region. 
These  are  the  adductor  surfaces  of  the  thighs  (the 
most  convenient  when  the  patient  is  to  rub  the 
ointment  into  his  person),  the  armpits  and  the 
regions  just  below,  extending  anteriorly,  and  the 
sub-scapular  regions  of  each  side. 

The  ointments  of  the  oxids  of  mercury  and  the 
oleate  of  mercury  are  more  irritant  than  the  mer- 
curial ointment  or  the  blue  ointment,  as  the  di- 
luted mercurial  ointment  is  now  called. 

Too  much  stress  can  not  be  placed  on  the  neces- 
sity of  giving  close  attention  to  the  various  bodily 
functions  during  the  mercurial  treatment  to  main- 
tain the  appetite  and  digestion  unimpaired,  to  reg- 
ulate the  bowels  and  to  secure  scrupulous  cleanli- 
ness of  the  body.  The  mouth  should  be  the  object 
of  especial  attention ; carious  teeth  should  be  filled 
and  the  mouth  and  teeth  kept  thoroughly  cleaned. 

THE  IODIDS. 

The  use  of  the  iodids,  like  that  of  mercury,  is 
well  established  on  clinical  evidence  and  we  can 
only  speculate  as  to  the  wa3r  in  which  it  produces 
its  effects  in  syphilis,  chronic  rheumatism  and 
asthma. 

OFFICIAL  PREPARATIONS. 

Iodum. — U.  S. — Iodin  occurs  in  bluish-black 
rhombic  plates  that  have  a metallic  luster,  a dis- 
tinctive odor  and  a sharp  and  acrid  taste.  It  is 
only  slightly  soluble  (1/5,000)  in  water,  but  is 


ALTERATIVES. 


115 


readily  soluble  in  ten  parts  of  alcohol.  It  is  also 
soluble  in  an  aqueous  solution  of  potassium  or  of 
sodium  iodid. 

Iodin  was  discovered  about  1812  by  Courtois, 
a French  manufacturing  chemist,  but  it  was  not 
used  in  medicine  until  after  1820,  when  its  medic- 
inal virtues  were  first  made  known  by  Dr.  Coin- 
det,  Sr.,  of  Geneva. 

Average  dose:  0.005  gm.  (5  mg.  or  1/10  grain). 

Liquor  Iodi  Compositus. — U.  S. — Compound 
Solution  of  Iodin  contains  5 per  cent,  of  iodin  and 
10  per  cent,  of  potassium  iodid  in  distilled  water. 

Average  dose:  0.20  c.c.  (3  minims). 

Tinctura  Iodi. — U.  S. — Tincture  of  Iodin,  as 
now  official,  represents  an  alcoholic  solution  of  7 
per  cent,  of  iodin  and  5 per  cent,  of  potassium 
iodid.  The  resulting  tincture  is  freely  miscible 
with  water  and  with  alcohol. 

Average  dose:  0.10  c.c.  (1%  minims). 

Acidum  Hydriodicum  Dilutum.— U.  S. — This 
is  a new  addition  to  the  Pharmacopeia  and  is  in- 
tended primarily  for  the  preparation  of  the  syrup 
of  hydroidic  acid.  It  should  contain  not  less  than 
10  per  cent,  by  weight  of  the  absolute  acid. 

Average  dose:  0.50  c.c.  (8  minims). 

Syrupus  Acidi  Hydriodici. — U.  S. — This  is  a 
clear,  colorless,  syrupy  liquid  that  contains  about 
1 per  cent,  of  absolute  hydriodic  acid. 

Average  dose:  4 c.c.  (1  fluidram). 

Attention  may  here  he  called  to  the  fact  that 
some  of  the  manufacturers  of  so-called  permanent 
syrup  of  hydriodic  acid  have  taken  advantage  of 
the  fact  that  glycerin  is  less  susceptible  to  chemic 
change  with  hydriodic  acid  than  syrup,  and  are, 
therefore,  offering  a gylcerite  or  hydriodic  acid 


116 


PHARMACOPEIA  AND  PHYSICIAN. 


under  the  name  of  syrup.  While  it  can  not  be 
definitely  proved  that  this  substitution  is  a danger- 
ous practice,  it  is,  nevertheless,  one  of  the  little 
dishonesties  that  are  so  frequent  in  other  lines  of 
trade  and  should  not  he  countenanced  in  connec- 
tion with  the  production  or  the  use  of  medicinal 
substances. 

Syrupus  Ferrt  Iodidi. — U.  S. — This  syrup,  in 
harmony  with  the  Brussels  conference  agreement, 
now  contains  about  5 per  cent,  by  weight,  of  fer- 
rous iodid. 

Average  dose:  1 c.c.  (15  minims). 

The  official  salts  of  iodin  are  all  freely  soluble 
in  water  and  are  also  soluble  in  alcohol  and  alco- 
holic liquids.  They  are,  in  the  order  of  their  pop- 
ularity and  use: 

POTASSII  IODIDUM. — IT.  S. 

SoDII  IODIDUM. — U.  S. 

SlRONTII  IODIDUM. — U.  S. 

Average  dose  of  any  of  the  above : 0.50  gm. 
(7i/j  grains). 

Ammonii  Iodidum. — U.  S. 

Average  dose:  0.25  gm.  (4  grains). 

While  mercury  is  employed  in  all  stages  of 
syphilis,  but  is  most  useful  in  the  second  stage, 
the  iodids  are  employed  in  the  second  and  third 
stages,  but  find  their  greatest  field  of  usefulness 
in  the  third.  The  iodids  enjoy  a peculiar  reputa- 
tion in  the  treatment  of  those  symptoms  of  tertiary 
syphilis,  such  as  periostitis,  which  are  manifested 
in  connection  with  the  bones. 

Bronchitis,  in  those  who  suffer  with  a rheumatic 
or  gouty  diathesis,  often  shows  greater  improve- 
ment under  the  influence  of  this  drug  than  with 
any  other  treatment. 


ALTERATIVES. 


117 


The  ioclids  are  rarely  used  alone  in  the  second 
stage  of  syphilis,  hut  in  combination  with  mercury, 
known  as  the  mixed  treatment,  already  referred  to, 
they  appear  to  be  of  value. 

There  can  be  no  doubt  of  the  usefulness  of  the 
iodids  in  relieving  the  symptoms  occurring  in  the 
third  stage  of  syphilis,  and  we  have  few  therapeu- 
tic facts  which  are  better  attested. 

The  saturated  solution  of  potassium  iodid  is, 
perhaps,  the  most  commonly  used  form  of  admin- 
istration. 

The  preparation  of  this  may  be  entrusted  to  the 
pharmacist  or  it  may  be  ordered  as  follows : 


R.  Potassii  iodidi  si  30 1 

Aqu®  dest.  q.  s.  ad fgi  30 1 


M.  Ft.  solut.  Sig. : Five  drops  after  eaclr  meal,  the 
dose  to  be  increased  by  one  drop  each  day. 

The  increase  in  the  amount  to  be  taken  may  be 
continued  until  the  symptoms  of  iodism  arise  or 
until  sixty  or  more  drops  are  taken  daily. 

The  patient  is  to  be  instructed  as  to  the  symp- 
toms to  be  expected,  such  as  pain  in  the  region  of 
the  parotid  gland,  etc. 

We  are  as  far  from  being  able  to  explain  the 
action  of  the  iodids  in  chronic  rheumatism  and 
asthma  as  in  syphilis,  but  their  usefulness  is  indis- 
putable and  unquestioned. 

It  is  of  little  consequence  whether  we  choose 
potassium  iodid  or  one  of  the  other  inorganic 
iodids  or  an  organic  preparation.  Potassium  iodid 
has  long  been  the  most  popular  of  all  of  the  avail- 
able preparations  and  will  probably  continue  to  be 
the  most  useful  or,  at  least,  the  most  frequently 
used. 


118 


PHARMACOPEIA  AND  PHYSICIAN. 


THYROID  GLAND. 

When  it  was  found  that  the  feeding  of  thyroid 
substances  would  obviate  the  symptoms  which  or- 
dinarily follow  the  removal  of  that  gland,  the  sug- 
gestion was  made  that  it  might  be  effective  in  com- 
bating the  symptoms  associated  with  disease  of  the 
gland.  This  was  found  to  be  true,  and  the  fact 
that. the  substance  is  effective  when  given  by  the 
stomach  at  once  suggested  that  there  must  he 
some  active  principle  found  in  the  gland.  This 
principle,  called  iodothyrin,  containing  9.3  per 
cent,  of  iodin,  possesses  the  same  therapeutic  prop- 
erties as  the  gland  substance;  under  its  uses  a 
great  increase  in  metabolism  occurs,  superfluous 
fat  disappears  and  an  increased  combustion  of 
proteid  takes  place,  explaining  its  use  in  obesity 
and  the  necessity  for  a diet  rich  in  proteid  when 
this  substance  is  used  for  such  conditions  as  myxe- 
dema. 

G-landulje  TiiYROiDiE  Siccae. — U.  S. — Des- 
iccated thyroid  gland  is  officially  described  as  “the 
cleaned,  dried  and  powdered  thyroid  glands  of  the 
sheep,  freed  from  fat.”  It  occurs  as  a yellowish 
amorphous  powder,  having  & peculiar  odor;  it  con- 
tains the  active  ingredients  of  the  thyroid  tissue. 
It  is  partially  soluble  in  water. 

Average  Dose:  0.25  gm.  (4  grains). 

Thyroid  gland  or  iodothyrin  is  indicated  in 
obesity,  after  removal  of  the  thyroid  or  when  the 
latter,  through  disease,  fails  to  function  properly, 
as  in  myxedema  and  in  hypoplastic  follicular  goi- 
ter. 

STOMACHICS. 

In  this  group  are  included  a number  of  agents, 
many  of  them  used  for  centuries,  with  actions 


STOMACHICS. 


119 


scarcely  better  understood  now  than  they  were  in 
the  remote  past.  They  include  those  agents  com- 
monly called  bitters  and  aromatics,  terms  which 
refer  only  to  taste,  or,  to  be  more  accurate  in  the 
case  of  aromatics,  to  taste  and  smell,  but  which 
are  employed  as  therapeutic  terms  for  want  of 
better,  thus  showing  how  little  we  know  of  their 
mode  of  action.  Despite  this  want  of  exact  know- 
ledge of  their  pharmacologic  action,  the  accumu- 
lated clinical  evidence  of  2,000  years  or  more  goes 
to  show  that  they  are  useful  in  slight  catarrhal 
conditions  and  in  minor  functional  disturbances 
of  the  alimentary  canal  in  which  there  are  no  ser- 
ious anatomic  changes. 

It  is  possible  that  their  beneficial  influence  is 
sometimes  due  in  part  to  the  physic  effect,  as  they 
are  agreeable  to  many  tastes,  and  their  regular  use 
may  encourage  the  patient — two  important  factors 
in  digestion. 

Most  of  the  experiments  that  have  hitherto  been 
conducted  with  these  agents  have  been  made  on 
animals,  and  the  results  have  been  variable  and 
often  contradictory,  hence  we  must  depend  almost 
entirely  on  clinical  evidence  for  guiding  us  in  their 
uses. 

Owing  to  the  great  variability  of  the  functions 
involved  and  the  natural  discrepancy  in  the  capa- 
bility of  various  observers,  most  inaccurate  conclu- 
sions are  reached,  and,  therefore,  no  attempt  can 
be  made  to  give  precise  information  as  to  the  exact 
relative  merits  of  one  member  rather  than  another 
in  a given  condition. 

Bidder  and  Schmidt,  in  1852,  observed  that  the 
sight  of  food  caused  the  secretion  of  gastric  juice  in 


120 


PHARMACOPEIA  AND  PHYSICIAN. 


a fasting  dog,  and  Pawlow,  in  1888,  proved  the 
existence  of  specific  secretory  nerve  fibers  in  the 
vagus,  and  that  the  gastric  secretion  is  stimulated 
reflexly  from  the  mouth.  That  the  taste  of  bitter 
substances  excites  the  flow  of  saliva  is  common  ex- 
perience, and  they  are  said  to  stimulate  reflexly  the 
gastric  secretion  when  they  are  taken  in  the  mouth. 
It  has  not  been  proved  that  the  bitters  have  any 
effect  on  pancreatic  secretion  in  animals,  but  it  is 
probable  that  they  do  stimulate  it  reflexly  in  man. 

Borissow  has  recently  studied  the  effects  on  gas- 
tric secretion  in  the  dog  of  bitter  substances  taken 
into  the  mouth  but  not  into  the  stomach.  He 
found  that  the  bitter  taste  caused  a marked  in- 
crease beginning  almost  immediately,  but  not  last- 
ing long.  He  therefore  advises  that  the  substance, 
preferably  in  liquid  form,  be  given  only  a short 
time  before  eating.  He  maintains  that  the  nega- 
tive results  obtained  by  Tschelzow  were  due  to  the 
use  of  excessive  amounts  of  bitter  extract  which  in- 
hibit the  digestive  action.  Bitter  substances  which 
pass  into  the  stomach  without  producing  a bitter 
taste  are  probably  without  effect  on  the  appetite 
and  digestion. 

Bitter  substances  in  the  stomach  have  been  found 
to  increase  the  number  of  leucocytes  in  the  blood, 
and,  according  to  Hofmeister,  the  leucocytes  are 
concerned  in  the  transportation  of  a part  of  the  di- 
gestive proteids  into  the  circulation.  The  bitters, 
therefore,  should  cause  a more  rapid  absorption  of 
the  digested  proteids.  It  can  not  be  stated  posi- 
tively whether  or  not  the  bitters  increase  the  gas- 
tric movements,  but  it  has  been  suggested  that  in- 
creased functional  activity  of  the  gastrointestinal 
canal  may  occur  from  reflex  stimulation,  due  to 


STOMACHICS. 


121 


irritation  of  certain  sensory  nerves  in  the  stomach, 
in  a manner  analogous  to  the  reflex  stimulation  of 
the  gastric  secretion  by  the  taste  or  sight  of  food. 

After  therapeutic  doses  of  the  simple  bitters 
have  reached  the  stomach  they  can  hardly  exert 
any  perceptible  effect  directly  on  the  activity  of 
the  gastric  juice,  and  this  extremely  slight  effect,  if 
adverse,  would  be  very  much  more  than  counter- 
balanced by  the  increased  amount  of  the  secre- 
tion. 

While  there  are  a number  of  official  substances 
that  may  he,  and  are,  used  as  simple  bitters  or 
stomachics,  it  will  not  be  necessary  to  enumerate 
more  than  a few  of  the  more  popular  to  illustrate 
the  variety  and  the  uses  of  this  class  of  drugs. 

Gentiana. — U.  S. — The  dried  rhizome  and 
roots  of  Gentiana  lutea,  constitute  by  far  the  best 
known  and  the  most  widely  used  of  all  simple  bit- 
ters. This  drug  is  not  alone  of  interest  medicin- 
ally, but  it  has  also  taken  an  important  part  in  the 
folklore,  traditions  and  legends  of  European  peo- 
ples. It  is  said  to  have  been  introduced  into  med- 
icine by  Gentius,  King  of  Illyria,  who  first  discov- 
ered its  medicinal  virtues. 

Fluidextractum  Gentian.®. — U.  S. — This  is 
made  with  diluted  alcohol. 

Average  dose:  1 c.c.  (15  minims). 

Entractum  Gentians. — IT.  S. — This  is  an 
aqueous  extract  of  gentian  evaporated  to  pilular 
consistence. 

Average  dose:  0.25  gm.  (4  grains). 

Tinctura  Gentian.®  Composita. — IT.  S. — This 
represents  10  per  cent,  of  gentian,  4 per  cent,  of 
bitter  orange  peel  and  1 per  cent,  of  cardamom  in 
60  per  cent,  alcohol. 


122 


PHARMACOPEIA  AND  PHYSICIAN. 


Average  dose:  4 c.e.  (1  liuidram).6 

Calumba. — U.  S. — The  dried  root  of  Jateorhiza 
palmata was  introduced  into  Europe  by  the  Portu- 
guese in  the  seventeenth  century  and  has  been 
much  employed  as  a simple  bitter  since  that  time, 
particularly  on  the  continent  of  Europe. 

Fluidextractum  Calumba. — TJ.  S. — This  is 
made  with  70  per  cent,  alcohol. 

Average  dose:  2 c.c.  (30  minims). 

Tinctura  Calumba. — TJ.  S. — This  represents 
20  per  cent,  of  the  crude  drug. 

Average  dose:  4 c.c.  (1  liuidram). 

Quassia. — TJ.  S. — The  wood  of  Picarasma  ex- 
celsa — Jamaica  quassia  or  of  Quassia  amara — Sur- 
inam quassia,  appears  to  be  more  popular  in  Eng- 
land than  in  this  country.  The  official  prepara- 
tions are: 

Fluidextractum  Quassi-E. — TJ.  S. — This  is 
made  with  33  per  cent,  alcohol. 

Average  dose:  0.5  c.c.  (8  minims). 

Extractum  Quassi-E. — TJ.  S. — This  is  an  aque- 


6.  The  compound  tincture  of  gentian  is  probably  the  most 
popular  of  all  stomachics  and  is  widely  used  either  alone  or 
in  combination  with  a mild  antacid,  such  as  sodium  bicar- 
bonate. A mixture  that  is  largely  used,  particularly  in  hos- 
pital practice,  may  be  compounded  somewhat  as  follows  : 


R.  Tinct.  gent,  comp 3x  40 

Sodii  bicarb gr.  xc  6 

Aquae  q.  s.  ad 3iii  100 


To  be  given  in  doses  of  2 or  3 teaspoonfuls  before  meals. 

Such  a prescription,  of  course,  may  be  varied  in  innumer- 
able ways,  the  addition  of  compound  tincture  of  cardamom 
will  not  alone  improve  its  appearance,  but  will  also  make  it 
much  more  acceptable,  in  that  it  makes  the  whole  mixture 
more  aromatic.  The  addition  of  tincture  of  capsicum,  0.2  c.c. 
or  0.3  c.c.  (3  to  5 minims)  to  each  dose,  makes  the  mixture 
sharp  and  pungent  and  may  be  desirable,  particularly  in' 
cases  of  alcoholic  gastritis. 


STOMACHICS. 


123 


ous  extract  of  quassia,  representing  ten  times  its 
weight  of  the  crude  drug. 

Average  dose:  0.05  gm.  (1  grain). 

Tinctura  Quassia. — U.  S. — This  represents 
20  per  cent,  of  quassia  in  35  per  cent,  alcohol. 

Average  dose:  2 c.c.  (30  minims). 

Two  other  drugs  which  are  frequently  used  by 
American  physicians  are  chirata  and  berberis. 

Chirata. — U.  S. — The  dried  plant  of  Swertia 
Chirayita  is  a comparatively  recent  addition  to 
European  medicine,  though  it  has  long  been  used 
and  held  in  high  esteem  by  the  Hindus.  The  only 
official  preparation  in  our  Pharmacopeia  is : 

Fluidextractum  Chiratae. — U.  S. — This  is 
made  with  diluted  alcohol. 

Average  dose:  1 c.c.  (15  minims). 

Berberis. — IT.  S. — (Barberry) — The  rhizome 
and  roots  of  Berberis  aquifolium. 

Fluidextractum  Berberis. — IT.  S. — This  is 
made  with  diluted  alcohol. 

Average  dose:  2 c.c.  (30  minims). 

AROMATICS. 

Aromatics  contain  volatile  oils,  on  which  they  de- 
pend for  their  flavor  and  for  a slightly  irritant  ac- 
tion on  the  mucous  membranes.  Brandi  found 
that  the  irritation  and  the  consequent  hyperemia 
of  the  mucous  membrane  of  the  alimentary  canal, 
due  to  sharp  tasting  substances,  caused  increased 
absorption  of  certain  products  of  digestion.  As 
the  aromatics  usually  have  an  agreeable  taste,  they 
probably  increase  gastric  secretion  by  reflex  stimu- 
lation, but  it  has  not  been  demonstrated  that  they 
increase  the  amount  of  hydrochloric  acid  or  of  the 
digestive  ferments. 


124 


PHARMACOPEIA  AND  PHYSICIAN. 


Gottlieb,  in  experimenting  on  rabbits  with  vola- 
tile oil  of  mustard  and  with  pepper,  found  an  in- 
creased pancreatic  secretion,  both  solids  and  liquids, 
from  irritation  of  the  gastric  mucous  membrane. 
He  admits  the  possibility  of  the  absorption  of  a 
part  of  such  volatile  substances  and  a consequent 
direct  stimulation  of  the  secretory  cells  of  the  pan- 
creas, but  he  obtained  a similar  increase  of  pan- 
creatic secretion  by  reflex  stimulation,  using  as  irri- 
tants 0.5  per  cent,  acid  and  strong  alkalies,  which 
are  not  nearly  so  apt  to  be  rapidly  absorbed.  Gott- 
lieb’s results  with  volatile  oil  of  mustard  have  been 
criticized  because  he  used  as  much  as  half  a drop 
for  a rabbit — a dose  which  might  be  termed  mas- 
sive, considering  the  size  or  the  weight  of  the  ani- 
mal, but  the  rabbit’s  gastrointestinal  canal  is  prob- 
ably not  so  easily  irritated  as  is  that  of  man. 

In  support  of  the  claim  that  the  pancreatic  se- 
cretion is  reflexly  stimulated  are  the  results  of 
Bernstein  and  Heidenhain’s  experiments  on  dogs. 
These  observers  found  that  pancreatic  secretion 
begins  so  soon  as  food  is  taken,  when  reflex  stimula- 
tion alone  could  cause  it. 

All  volatile  oils  have  an  antiferment  action,  and 
the  aromatics,  therefore,  may  lessen  gastric  fer- 
mentation. 

The  slightly  irritant  effect,  with  the  hyperemia, 
must  be  the  main  factors  in  their  effects  on  diges- 
tion after  that  of  reflex  stimulation,  for  pancreatic 
secretion  has  been  found  to  be  much  more  mark- 
edly influenced  by  the  dilation  of  blood  vessels  and 
a consequently  free  circulation  than  by  changes  of 
blood  pressure : thus  free  secretion  has  been  ob- 


STOMACHICS. 


125 


served  after  chloral,  with  dilated  vessels  and  low 
blood  pressure. 

In  this  connection  it  is  to  be  remembered  that 
nausea,  pain  in  the  stomach  and  other  symptoms 
of  functional  disturbances  of  the  gastrointestinal 
canal  are  often  promptly  relieved  by  external  ap- 
plication of  heat  or  even  by  a mustard  footbath, 
which  can  only  act  reflexly. 

It  is  easy  to  understand  why  pure  air  and  inter- 
esting surroundings  play  such  an  important  role 
in  appetite  and  digestion  when  we  consider  how 
completely  those  functions  are  under  the  control 
of  the  reflexes,  mere  change  of  location  being  much 
less  important  than  the  substitution  of  interesting 
for  monotonous  surroundings,  and  in  advising 
change  of  scene  with  outdoor  life  these  details 
can  not  be  too  carefully  considered. 

Bitters,  and  more  particularly  the  aromatic  bit- 
ters, are  indicated  in  loss  of  appetite  when  it  is  not 
due  to  grave  gastric  disturbances.  When  catarrh 
of  the  gastric  mucous  membrane  complicates  the 
condition,  an  astringent  bitter,  such  as  serpenta- 
ria,  cimicifuga  or  cinchona,  should  be  used.  In  the 
absence  of  catarrh,  indigestion  accompanied  by  in- 
sufficient gastric  secretion,  a simple  bitter,  such  as 
gentian  or  calumba,  may  be  used  alone,  but  it  is 
very  much  more  often  advisable  to  combine  the 
simple  bitters  with  aromatics. 

The  individual  taste  of  the  patient  should  al- 
ways be  considered  in  the  choice  of  the  aromatic. 
Men  often  like  simple  bitters,  such  as  gentian  or 
gentian  and  orange,  a fact  attested  by  the  extraor- 
dinary popularity  a few  years  ago  of  a certain  bit- 
ters, which  consisted  practically  of  compound  tine- 


126 


PHARMACOPEIA  AND  PHYSICIAN. 


ture  of  gentian.  Women  usually  prefer  mildly  aro- 
matic and  not  very  bitter  substances,  while  chil- 
dren are  generally  averse  to  them  altogether. 

When  excess  of  acidity  exists  bitter  substances 
will  probably  increase  the  trouble.  Just  as  bitters 
and  aromatics  produce  a greater  effect  in  cases  of 
functional  disturbances,  so  iron  is  useful  in  ane- 
mia. though  it  has  little  influence  in  health,  and  it 
is  often  found  advisable  to  combine  iron  with  bit- 
ters, in  which  case  the  astringents  are  to  be  avoided 
because  of  the  chemic  reaction,  whereby  an  inky 
mixture  is  formed,  disagreeable  alike  to  sight  and 
taste — two  great  objections  in  this  class  of  reme- 
dies. 

Many  hitters  which  are  not  usually  classed  as 
astringents  contain  enough  tannin  or  similarly  act- 
ing substances  to  give  inky  mixtures  with  ferric 
salts ; such,  for  instance,  are  gentian  and  nux 
vomica.  Calumba,  therefore,  is  to  be  given  the 
preference  in  all  cases  in  which  a bitter  is  to  be 
combined  with  a soluble  salt  of  iron.  Detannated 
preparations  of  cinchona  and  even  solutions  of  the 
cinchona  alkaloids  have  little  to  recommend  them 
in  preference  to  calumba  as  a simple  bitter. 

The  following  is  an  example  of  a simple  bitter 
combined  with  iron : 


R. 

Tinct.  calumbae 

Jiii  1001 

Tinct.  ferri  chloridi . . 

m.  Ixxv  5| 

Aquae  q.  s.  ad 

Jvi  200 1 

M. 

Sig. : A tablespoonful  may  be  given  half  an  hour 

before 

meals  to  men.  while 

a teaspoonful  will  usually 

suffice  for  women.1 

7.  While  small  doses  of  iron,  well  diluted,  may  be  given 
with  bitters  before  meals,  if  larger  doses  are  given  after 
eating  they  are  borne  better  than  they  would  be  if  given  on 
an  empty  stomach. 


STOMACHICS. 


127 


The  possible  combinations  of  aromatic  bitters 
are  infinite,  and,  as  previously  stated,  the  indi- 
vidual taste  is  to  be  considered  rather  than  slavish 
adherence  to  any  one  formula. 

Of  the  official  aromatic  bitters  we  may  enumer- 
ate: 

Calamus.  — TJ.  S.  — Sweet  Flag.  — The  dried 
rhizome  of  Acorus  Calamus  was  known  to  the  an- 
cients and  is  still  largely  used  in  Europe,  though 
not  so  popular  in  this  country. 

Fluidextractum  Calami. — U.  S. — This  is 
made  with  75  per  cent,  alcohol. 

Average  dose:  1 e.c.  (15  minims). 

Aurantii  Amari  Cortex.  — U.  S.  — Bitter 
Orange  Peel. — The  dried  rind  of  the  unripe  fruit 
of  Citrus  vulgaris  has  long  been  used  as  an  aro- 
matic bitter,  but  is  chiefly  used  as  an  addition  to 
other  drugs,  as  in  the  compound  tincture  of  gen- 
tian and  the  compound  tincture  of  cinchona. 

Fluidextractum  Aurantii  Amari. — U.  S. — 
This  is  made  with  65  per  cent,  alcohol. 

Average  dose:  1 c.c.  (15  minims). 

Tincture  Aurantii  Amari. — U.  S. — This  rep- 
resents 20  per  cent,  of  the  crude  drug  and  contains 
60  parts  of  alcohol. 

Average  dose:  4 c.c.  (1  fluidram). 

ASTRINGENT  BITTERS. 

Drugs  that  might  properly  be  classed  as  astrin- 
gent bitters  are  numerous,  and,  therefore,  we  shall 
enumerate  but  a few  of  the  more  interesting  or 
more  popular. 

Cimicifuga. — U.  S. — The  dried  rhizome  and 
roots  of  Cimicifuga  racemosa,  a plant  that  is  a na- 


128 


PHARMACOPEIA  AND  PHYSICIAN. 


tive  of  North  America,  have  been  used  extensively 
in  some  sections  of  the  United  States. 

Fluidextractum  Cimicifuga. — U.  S. — This  is 
made  with  strong  alcohol. 

Average  dose:  1 c.c.  (15  minims). 

Tinctura  Cimicifuga. — U.  S. — This  is  made 
with  alcohol. 

Average  dose:  4 c.c.  (1  fluidram). 

Serpentaria. — U.  S. — The  rhizome  and  roots 
of  Aristolochia  Serpentaria,  popularly  known  as 
Virginia  snakeroot,  have  been  used  in  Europe  for 
over  200  years. 

Fluidextractum  Serpentaria. — U.  S. — This 
is  made  with  80  per  cent,  alcohol. 

Average  dose:  2 c.c.  (30  minims). 

Tinctura  Serpentaria. — U.  S. — This  repre- 
sents 20  per  cent,  of  the  crude  drug  and  is  made 
with  a menstruum  containing  65  parts  of  alcohol. 

Average  dose:  4 c.c.  (1  fluidram). 

Hydrastis.— U.  S.- — -The  rhizome  and  rootlets 
of  Hydrastis  canadensis,  a perennial  plant  that  is 
indigenous  to  Canada  and  the  United  States  east 
of  the  Mississippi  Eiver. 

Fluidextractum  Hydrastis. — U.  S. — This  is 
made  with  a menstruum  containing  60  parts  of 
alcohol,  with  glycerin  and  water,  and  should  con- 
tain not  less  than  2 per  cent,  of  hydrastin. 

Average  dose:  2 c.c.  (30  minims). 

Tinctura  Hydrastis. — U.  S. — This  represents 
20  per  cent,  of  the  crude  drug  and  is  made  with  65 
per  cent,  alcohol. 

Average  dose:  4 c.c.  (1  fluidram). 

Cinchona. — U.  S. — While  undoubtedly  better 
known  and  more  extensively  used  as  a bitter  stoma- 
chic than  any  of  the  preceding,  it  is  unnecessary 


STOMACHICS. 


129 


to  recount  the  origin  or  the  uses  of  this  drug.  It  is 
official  under  two  titles:  Cinchona  and  Cinchona 
Eubra.  Of  the  former  we  have : 

Fluidextractum  Cinchona. — U.  S. — This  is 
made  with  80  per  cent,  alcohol  and  contains  4 per 
cent,  of  the  ether-soluble  alkaloids  of  cinchona. 

Average  dose:  1 c.c.  (15  minims). 

Tinctura  CiNCHONiE. — U.  S. — This  represents 
20  per  cent,  of  the  crude  drug  and  should  contain 
0.75  per  cent,  of  cinchona  alkaloids. 

Average  dose:  4 c.c.  (1  fluidram). 

The  only  official  preparation  of  red  cinchona  is 
the  old,  and  still  popular,  Huxham’s  tincture  of 
bark. 

Tinctura  Cinchona  Composita. — U.  S. — 
This  represents  10  per  cent,  of  red  cinchona,  8 
per  cent,  of  bitter  orange  peel  and  2 per  cent,  of 
serpentaria. 

Average  dose:  4 c.c.  (1  fluidram). 

For  an  astringent  bitter  the  fluid  extract  or  the 
tincture  of  cinchona,  cimicifuga  or  serpentaria 
may  be  combined  somewhat  as  follows : 

R.  Fl.  ext.  cinchona 

Tinct.  gentian*  comp.,  aa 3xii  50 1 

M.  Sig. : One  teaspoonful  to  be  given  before  meals. 

For  women  it  will  be  well  to  increase  the  amount 
of  aromatics,  in  which  case  the  compound  tincture 
of  cardamom  may  be  substituted  for  the  compound 
tincture  of  gentian  and  the  mixture  even  further 
diluted  with  aromatic  elixir,  if  thought  desirable, 
as  follows: 

R.  Fl.  ext.  cinchona 3v  20 1 

Tinct.  cardamomi  comp. 

Elixir  aromatici,  aa 3x  40 1 

M.  Sig. : One  teaspoonful  of  this  mixture,  with 

water,  to  be  given  before  meals. 


130 


PHARMACOPEIA  AND  PHYSICIAN. 


Nux  Vomica. — U.  S. — The  dried  ripe  seed  of 
Strychnos  Nux  vomica,  although  not  containing 
sufficient  tannin  to  be  classed  as  an  astringent  bit- 
ter, is  frequently  used  as  a bitter  stomachic.  The 
available  preparations  are : 

Fluidextractum  Nucis  Vomicae. — U.  S. — 
This  contains  1 per  cent,  of  strychnin. 

Average  dose:  0.05  c.c.  (1  minim). 

Tinctura  Nucis  VoMiciE. — U.  S. — This  con- 
tains 2 per  cent,  of  extract  of  nux  vomica  and  is 
assayed  to  contain  0.1  per  cent,  of  strychnin. 

Average  dose:  0.6  c.c.  (10  minims).8 

CARMINATIVES. 

The  origin  of  this  word  is  in  doubt,  some  au- 
thorities maintaining  that  it  comes  from  carmen,  a 
charm,  and  the  term  is  even  now  used  somewhat 
loosely  for  those  agents  which  produce  a sense  of 
warmth  and  well-being  and  which  act  as  antispas- 
modics,  or  which  expel  gases  from  the  gastrointes- 
tinal canal.  When  given  with  cathartics  they 
lessen  the  griping  pain  of  these  drugs,  and,  being 

8.  A mixture  of  nux  vomica  and  sodium  bicarbonate  offers 
a number  of  advantages  as  an  efficient  and  comparatively 
harmless  stomachic.  It  is  made  as  follows  : 


R.  Tinet.  nucis  vom m.  lxxv  51 

Sodli  bicarb gr.  cl  10 1 

Aqu®  dest.  q.  s.  ad  5v  150 1 


Although  technically  this  formula  involves  an  incom- 
patibility, practically  it  is  very  satisfactory  indeed.  If  the 
mixture  is  filtered  and  allowed  to  stand  for  24  hours  before 
being  dispensed  it  will  be  found  to  have  developed  a very 
pleasant  ethereal  odor  that  adds  materially  to  its  effective- 
ness. The  usual  dose  for  adults  is  one  tablespoonful  before 
meals.  For  a patient  with  chronic  constipation  the  addition 
of  1 or  2 c.c.  (15  to  30  minims)  of  the  fluidextract  of  cascara 
sagrada  will  be  found  to  be  highly  satisfactory.  One  argu- 
ment In  favor  of  this  combination  is  that  tt  contains  little 
alcohol — virtually  none. 


STOMACHICS. 


131 


antiseptic,  they  inhibit  the  formation  of  gas  by 
fermentation. 

According  to  the  accepted  definition  a greater  or 
less  number  of  substances  can  be  included  in  this 
particular  class.  The  official  carminatives  afford  a 
very  wide  range  of  choice^  as  they  include  practi- 
cally all  aromatic  bitters,  nearly  all  the  aromatic 
volatile  oils,  besides  such  substances  as  ginger  and 
capsicum,  which  contain  pungent  resinous  constitu- 
ents, alcohol,  ether,  chloroform  and  many  other 
agents  which  produce  a sense  of  warmth  when  swal- 
lowed. 

Carminatives  are  among  the  most  ancient  of  rem- 
edies and  are  indicated  in  pain  in  the  stomach  or 
bowels  when  due  to  simple  indigestion  or  disten- 
tion by  gas,  but  not  when  there  is  inflammation: 
in  the  latter  case — for  instance,  in  appendicitis  or 
in  peritonitis — carminatives  are  apt  to  augment 
the  trouble. 

Many  of  these  substances  are  well  known  as 
household  remedies  and,  therefore,  it  will  suffice  to 
enumerate  only  the  more  important  ones. 

Zingiber. — U.  S. — Ginger  has  been  used  from 
time  immemorial  in  eastern  Asia;  it  was  well 
known  to  the  ancient  Greeks,  and  is  even  now. 
perhaps,  the  most  popular  of  all  the  carminatives. 
The  most  widely  used  of  the  official  preparations  is 
the  tincture. 

Tinctura  Zingiberis. — U.  S. — This  represents 
20  per  cent,  of  the  crude  drug  exhausted  with  alco- 
hol. 

Average  Dose:  2 c.c.  (30  minims). 

Dluidexteactum  Zingiberis. — IT.  S. — This  is 
an  alcoholic  extract. 

Average  Dose:  1 c.c.  (15  minims). 


132 


PHARMACOPEIA  AND  PHYSICIAN. 


Oleoresina  Zingiberis. — U.  S. — This  is  now 
prepared  by  means  of  acetone. 

Average  Dose:  0.03  gm.  (%  grain). 

Half  a teaspoonful,  as  noted  above,  of  the  tinc- 
ture may  be  given  in  a little  hot  water  or  with 
sugar. 

The  oleoresin  is  much  more  active,  and  a drop 
of  it  may  be  thoroughly  well  mixed  with  powdered 
sugar  and  from  one-eighth  to  one-fourth  of  the 
quantity  given  to  a child,  but  not  to  an  infant.  It 
may  also  be  added  in  half-drop  doses  or  less  to 
bulky  cathartic  pills  or  mixtures,  but  in  either  case 
it  should  be  well  diluted. 

THE  OFFICIAL  MINTS. 

Of  the  large  number  of  aromatic  drugs  of  the 
mint  family,  two  have  attained  more  than  ordinary 
popularity  as  carminatives.  The  revisers  of  the 
Pharmacopeia  have,  indeed,  been  impartial  in  their 
description  of  these  two  substances  and  have 
treated  them  absolutely  alike,  so  that  from  their 
status  as  official  drugs  it  would  be  difficult  to  say 
whether  peppermint  or  spearmint  should  be  ac- 
corded the  preference.  It  will  be  safe  to  assert, 
however,  that  peppermint  is  the  more  widely  used. 
It  is  official  as : 

Mentha  Piperita.  — U.  S.  — Peppermint.  — 
The  dry  leaves  and  flowering  tops.  • 

Average  Dose:  4 gm.  (1  dram).  This  is  some- 
times used  in  infusion. 

Oleum  Menthh?  Piperita. — U.  S. — This  is  a 
volatile  oil  distilled  from  the  fresh  and  partly  dried 
leaves  and  flowering  tops  of  peppermint. 

Spiritus  Mentha  Piperita. — U.  S. — This  is 
an  alcoholic  solution  of  10  parts  of  oil  of  pepper- 


STOMACHICS. 


133 


mint  filtered  through  1 part  of  bruised  peppermint, 
which  imparts  to  it  a distinct  greenish  color. 

Average  dose:  2 c.c.  (30  minims). 

Aqua  Menth^e  Piperita. — U.  S. — This  is  a 
saturated  aqueous  solution  of  oil  of  peppermint. 

Average  dose:  15  c.c.  (4  fluidrams) . 

As  above  noted,  spearmint,  Mentha  viridis , is 
official  under  closely  corresponding  headings  and 
the  doses  are,  of  course,  the  same. 

The  uses  of  these  official  mints  are  too  numerous 
and  too  well  known  to  require  description  in  detail. 
They  appear  to  be  particularly  useful  in  gastric 
fermentation,  for  which  purpose  they  are  usually 
given  in  connection  with  a mild  alkali,  like  sodium 
bicarbonate,  preferably  in  the  well-known  mixture 
of  soda  mint  of  the  National  Formulary  or  the 
widely  used  soda-mint  tablets.9 

Accumulations  of  gas  in  the  stomach  which 
prove  most  distressing  can  often  be  promptly  re- 
lieved by  administration  of  20  grains  of  sodium 
bicarbonate  or  potassium  bicarbonate  dissolved, 
preferably  in  hot  water,  to  which  from  10  to  20 
drops  of  spirit  of  peppermint  or  spearmint  may  be 
added. 


9.  The  Mistura  Sod®  et  Menthse  of  the  National  Formu- 
lary consists  of  : 


Sodium  bicarbonate  grs.  lxxv  5| 

Aromatic  spirit  of  ammonia m.  1 II 

Spearmint  water  to  make Jiii  100 1 

Mix  and  filter. 


The  average  dose  of  this  preparation  is  from  2 to  3 tea- 
spoonfuls. 

Soda  mint  tablets  as  furnished  by  manufacturers  usually 
consist  of  0.3  gm.  (5  grains)  of  sodium  bicarbonate  with 
0.002  (1/30  minim)  of  oil  of  peppermint. 


134 


PHARMACOPEIA  AND  PHYSICIAN. 


ASAFETIDA. 

Asafcetida. — U.  S. — A gum  resin  obtained 
from  the  root  of  one  or  more  species  of  Ferula. 
was  held  in  high  esteem  by  the  ancient  Greek 
physicians  and  has  been  popular  with  all  classes 
of  medical  practitioners  since  that  time. 

Average  dose:  0.25  gm.  (4  grains). 

As  an  addition  to  other  carminatives,  asafetida 
in  substance  was  at  one  time  very  popular.  At 
present  it  is  but  infrequently  administered  in  any 
other  form  than  suppositories.  These  are  largely 
used  after  surgical  operations  to  overcome  the 
atony  and  partial  paralysis  that  frequently  accom- 
panies surgical  interference  in  the  abdomen.  The 
only  official  preparations  containing  asafetida  in 
substance  are: 

Pilule  Asafietida. — U.  S. — Each  pill  con- 
tains 0.2  gm.  (3  grains)  of  asafetida  and  0.06  gm. 
(1  grain)  of  soap. 

Average  dose : 2 pills. 

Tincturf  Asafcetida. — U.  S. — This  repre- 
sents 20  per  cent,  of  asafetida  in  alcohol. 

Average  dose:  1 c.c.  (15  minims). 

Emulsum  Asafcetida. — IT.  S. — This  represents 
4 per  cent,  of  asafetida  in  water. 

Average  dose:  15  c.c.  (4  fluidrams). 

This  preparation  is  also  used  extensively,  as  a 
clyster,  to  relieve  accumulations  of  gas  in  the  in- 
testines, after  abdominal  operations.  It  was  at  one 
time  a very  popular  remedy  for  colic  in  infants,  but 
the  nauseous  taste  makes  it  very  disagreeable  and 
the  greater  number  of  infantile  complaints,  in 
which  it  might  be  indicated,  are  much  more  effec- 
tively treated  with  a laxative  such  as  castor  oil  or 


STOMACHICS. 


135 


magnesia,  and  by  the  application  of  heat  to  the 
abdomen. 

The  pernicious  habit  of  using  such  preparations 
as  Mrs.  Winslow's  Soothing  Syrup,  Chamberlain's 
Colic,  Cholera  and  Diarrhea  Remedy,  Kopp’s  Baby 
Friend10  and  others  which  have  been  exposed  in 
The  Journal,  can  not  be  too  strongly  condemned. 
If  an  opiate  is  thought  to  be  necessary,  it  is  much 
better  to  advise  the  nurse  or  mother  to  give  five 
drops  or  more  of  paregoric,  with  warnings  about 
the  disadvantages  and  the  dangers  of  its  indiscrimi- 
nate use. 

CHLOROFORM  AND  ETHER. 

Chloroform. — TJ.  S. — As  a carminative,  chloro- 
form probably  deserves  a much  more  extended  use 
than  it  now  has. 

Average  dose:  0.3  c.c.  (5  minims).  This  may 
be  given  either  on  sugar,  in  shaved  ice,  or  in  ice- 
cold  water. 

Spiritus  Chloroformi. — TJ.  S. — This  contains 
6 per  cent,  of  chloroform  in  alcohol. 

Average  dose:  2 c.c.  (30  minims). 

Emulsum  Chloroformi. — TJ.  S. — This  con- 
tains 4 per  cent,  of  chloroform  with  a small  propor- 
tion of  expressed  oil  of  almonds,  emulsified  with 
tragacanth. 

Average  dose:  8 c.c.  (2  fluidrams). 

The  spirit  of  chloroform,  diluted  with  aromatic 
elixir,  or  the  emulsion  of  chloroform  given  alone, 
promptly  affords  a sense  of  warmth  in  the  stom- 
ach and  will  usually  give  relief  in  cases  of  colic 
and  pain. 

JEther. — TJ.  S. — Ether,  sulphuric  ether  of  the 


10.  See  The  Jocrxal  A.  M.  A.,  vol.  xliv,  p.  666. 


136 


PHARMACOPEIA  AND  PHYSICIAN. 


early  pharmacopeias  has  long  been  in  nse  as  a car- 
minative. 

Average  dose:  1 c.c.  (15  minims). 

Spiritus  TEtheris. — U.  S. — This  contains 
about  33  per  cent,  of  ether. 

Average  dose:  4 c.c.  (1  fluidram). 

Spiritus  aEtheris  Composites. — TJ.  S. — The 
well-known  and  widely  used  Hoffman’s  anodyne 
contains  in  addition  to  ether  about  2.5  per  cent,  of 
ethereal  oil. 

Average  dose:  4 c.c.  (1  fluidram). 

Compound  spirit  of  ether,  in  addition  to  its 
other  uses,  has  long  enjoyed  a special  reputation  in 
hysteria  due  to  gastric  disturbances.  It  is  disagree- 
able to  the  taste,  however,  and  probably  possesses 
no  advantage  over  hot  whisky  and  water,  or  spirit 
of  nitrous  ether. 

Alcoholic  liquids  in  general  are  often  useful,  but 
their  use  and  their  numerous  disadvantages  can 
not  be  advantageously  discussed  in  this  connection. 

cloves  and  other  aromatic  substances. 

Caryophyllus.  — TJ.  S.  — Cloves.  — The  dried 
flower  buds  of  Eugenia  aromatica.  This  remedy 
appears  to  have  been  known  to  the  early  Egyptians, 
but  was  not  known  to  the  later  Greeks.  In  Europe 
this  drug,  probably  introduced  by  the  Arabians, 
has  been  known  for  centuries. 

Average  dose:  0.25  gm.  (4  grains). 

Oleum  Caryophylli. — TJ.  S.— This  is  a vola- 
tile oil  distilled  from  cloves. 

Average  dose:  0.05  c.c.  (1  minim). 

The  oil  of  cloves  is  much  more  frequently  used 
for  its  anesthetic  and  caustic  effect  on  exposed 
nerves  in  carious  teeth  than  as  a carminative,  but 


STOMACHICS. 


137 


it  may  be  used  for  the  latter  purpose,  iu  which  case 
it  is  better  to  add  it  to  spirit  of  peppermint  or 
some  other  alcoholic  carminative  preparation,  be- 
fore diluting  with  water. 

Oil  of  cinnamon  resembles  oil  of  cloves  in  its 
carminative  effect,  and  the  official  tincture  of  cin- 
namon is  also  useful  for  the  same  purpose,  but  is 
more  commonly  employed  as  an  adjuvant  or  flavor 
for  other  more  active  carminative  agents,  and  in 
diarrhea. 

Mustard,  pepper  and  nutmeg  are  not  used  med- 
icinally as  carminatives,  but  are  much  employed  as 
condiments  to  serve  practically  the  same  purpose. 


CHAPTER  Y. 


ASTRINGENTS. 

Astringents  are  substances  which  produce  a con- 
striction of  all  the  solid  tissues  with  which  they  are 
brought  into  intimate  contact.  All  substances 
that  are  capable  of  forming  precipitates  of  albu- 
min and  gelatin,  which  are  insoluble  in  the  body 
fluids,  are  capable  of  acting  as  astringents.  Sub- 
stances of  this  class  have  a peculiar  action  on  mu- 
cous membranes,  causing  wrinkling  of  their  sur- 
faces and  diminution  of  secretion ; they  precipitate 
not  only  proteids  and  gelatin,  but  also  alkaloids 
and  many  glucosids. 

The  action  of  astringents,  irritants  and  caustics 
is  largely  a matter  of  degree,  the  caustics  acting  as 
astringents  when  sufficiently  diluted,  while  all  as- 
tringents produce  at  least  a transient  and  slight 
irritation,  and  when  applied  in  concentrated  form 
to  mucous  membranes  many  of  those  classed  as 
mere  astringents  are  capable  of  causing  consider- 
able irritation,  which  in  the  stomach  may  give  rise 
to  vomiting,  and  in  the  intestine  to  diarrhea.  Some 
astringents  are  essentially  mild  in  their  action, 
while  others,  being  nearly  insoluble,  can  not  be 
brought  into  intimate  contact  with  the  tissues  in 
concentrated  form;  these  can  not  produce  more 
than  a very  mild  and  fleeting  irritation,  or  stimu- 
lation, which  is  followed  by  lessened  permeability 
of  the  capillary  walls  and  diminished  congestion. 

Bv  their  irritant  action,  drugs  of  this  partic- 


ASTRINGENTS. 


139 


ular  class  may  increase  a severe  acute  inflamma- 
tion without  being  able  to  produce  their  typical  as- 
tringent effect,  hence  they  are  not  nearly  so  useful 
in  such  conditions  as  in  chronic  inflammations. 
The  vegetable  astringents  owe  their  action  mainly 
to  the  presence  of  tannins,  substances  belonging  to 
an  ill-defined  group,  possessing  an  astringent  ac- 
tion as  their  best  defined  property.  Other  or- 
ganic acids  play  only  a minor  role  as  astringents. 
The  tannins  give  blue-black  or  greenish-black  re- 
actions with  ferric  salts;  they  precipitate  proteids 
(leather  being  the  product  formed  with  connective 
tissue),  alkaloids,  metals  and  some  other  sub- 
stances; they  yield  pyrocatechin  or  pyrogallol  on 
destructive  distillation.  Their  therapeutic  actions 
are  independent  of  their  chemical  peculiarities,  and 
they  are  severally  indicated  rather  with  reference 
to  the  presence  or  absence  of  extractive  matter. 

The  combination  of  tannin  with  peptone  is  sol- 
uble in  the  gastric  juice,  and  this  and  the  insoluble 
albumin  tannates  are  decomposed  in  the  alkaline 
juice  of  the  intestine,  the  tannin  forming  alkaline 
tannates  which  possess  little  or  no  astringent  ac- 
tion. If  the  free  tannins  reach  the  intestine  after 
the  administration  of  extracts  of  the  crude  drugs, 
they  act  on  the  mucous  membrane,  lessening  intes- 
tinal secretion;  this  greatly  modifies  the  bacterial 
development,  and,  therefore,  the  general  intestinal 
conditions.  Some  of  the  metallic  albuminates  are 
soluble  in  an  excess  of  proteid,  and  when  in  such  a 
case  the  liberated  acid  is  corrosive,  there  is  a pen- 
etrating corrosive  action  such  as  that  of  zinc  or 
mercuric  chlorid.  With  an  insoluble  precipitate, 
sucb  as  lead  albuminate,  which  forms  an  imper- 
vious coating,  and  a mildly  astringent  acid,  like 


140 


PHARMACOPEIA  AX D PHYSICIAN. 


acetic,  there  is  a typical  astringent  and  non-irri- 
tant effect. 

The  same  astringent  substance  may  be  used  in  a 
variety  of  conditions,  and  a number  of  different 
astringents  are  applicable  to  a given  condition.  A 
better  acquaintance  with  the  different  tannins  may 
lead  to  the  selection  of  certain  ones  for  particular 
cases,  but  at  the  present  time  we  are  guided  more 
by  the  physical  condition  in  which  a given  one  is 
available;  thus  the  official  tannic  acid  is  readily 
dissolved  in  the  stomach,  where  it  combines  with 
the  proteid  of  the  content,  or  with  the  mucous  mem- 
brane, whereas  the  tannin  of  gambir  (gambir  re- 
places the  catechu  of  the  Pharmacopeia  of  1890)  is 
protected  by  the  presence  of  gum  and  extractives, 
and  so  passes  into  the  intestine,  there  to  exert  its 
astringent  effect.  We  can  not  attempt  anything 
like  a complete  enumeration  of  the  various  uses  of 
the  astringents,  but  must  content  ourselves  with 
summarizing  briefly  the  principal  indications  of 
astringents  and  some  of  the  chief  characteristics 
of  the  more  common  remedies  of  this  type. 

USES  OF  ASTRINGENTS. 

Astringents  are  used  internally  in  the  treatment 
of  diarrhea  and  dysentery,  in  congestion  of  the  mu- 
cous membrane  of  the  stomach  and  intestines,  and 
for  hemorrhage  in  the  alimentary  canal  and  other 
directly  accessible  regions.  The  use  of  astringents 
— either  organic  or  inorganic — for  their  effects  on 
parts  which  can  only  be  reached  by  way  of  the 
blood  vessels  is  wholly  irrational,  and  when  benefit 
follows  it  is  not  due  to  the  astringent  action,  since 
by  their  very  nature  astringents  can  not  exist  free 
in  the  blood  in  sufficient  concentration  to  exert  an 


ASTRINGENTS. 


141 


astringent  action.  Traces  of  tannin  are  not  as- 
tringent any  more  than  the}"  are  irritant,  and  as- 
tringents act  only  when  brought  into  intimate  con- 
tact with  the  tissue  in  sufficient  concentration. 

The  metals  are  poisonous  when  absorbed,  and, 
as  a rule,  vegetable  astringents  are  to  be  preferred 
for  internal  administration,  particularly  when  they 
must  be  used  for  a considerable  period.  Pure  tan- 
nin. or  tannic  acid,  as  it  is  designated  in  the 
Pharmacopeia,  may  be  used  locally  whenever  a 
purely  astringent  action  is  indicated;  for  example, 
when  secretion  is  excessive,  and  when  it  is  desired 
to  harden  the  skin  in  order  to  prevent  excessive 
sweating. 

The  treatment  of  accessible,  inflamed  mucous 
membranes  with  antiseptic  solutions,  and  more 
parficularl}"  with  solutions  of  hydrogen  dioxid,  has 
greatly  lessened  the  use  of  astringents,  and  the 
cleansing  of  an  infected  surface  should  be  a rou- 
tine procedure  even  when  an  astringent  is  to  be 
applied  subsequently.  Dry  tannin  insufflated 
against  an  elongated  palate  often  affords  instan- 
taneous relief. 

Tannin  in  the  pure  state  is  rarely  used  inter- 
nally because  of  its  irritant  action  on  the  stomach, 
one  of  the  preparations  of  astringent  drugs  being 
preferred  in  such  cases.  The  dry  powder  acts  as  a 
styptic  when  applied  to  bleeding  surfaces,  but  it 
must  be  borne  in  mind  that  tannic  acid  and  all 
other  astringents  when  given  by  mouth  exert  their 
astringent  action  only  on  the  alimentary  canal. 

The  various  proprietary  remedies,  composed  of 
tannin  and  albumin,  gelatin  or  albuminoids,  have 
not  been  shown  to  possess  any  decided  therapeutic 
advantages  over  the  official  astringents,  and  sev- 


142  PHARMACOPEIA  AND  PHYSICIAN. 

eral  of  the  proprietary  compounds,  owing  to  their 
variable  composition,  must  necessarily  be  uncertain 
in  their  actions. 

Tannic  acid  in  simple  solution  combines  with 
the  albuminous  contents  of  the  stomach,  and  with 
the  mucous  membrane  itself  if  the  stomach  be 
empty  and  the  tannin  in  concentrated  solution; 
it  may  then  give  rise  to  vomiting  and  even  to 
diarrhea.  This  irritant  action  of  the  astringents 
leads  to  the  use  of  several  of  them — alum,  and  zinc 
and  copper  sulphate — as  emetics. 

Tannin,  being  a precipitant  of  alkaloids,  is  use- 
ful as  an  antidote  to  those  poisons  when  they  are 
in  the  stomach— not  when  they  have  been  given 
hypodermically,  except  possibly  in  the  case  of  mor- 
phin,  which  is  excreted  into  the  stomach.  The  tan- 
nates  thus  formed  are  slowly  broken  up,  and  the 
stomach  must  be  evacuated  by  emetics,  or.  prefer- 
ably, by  the  stomach  pump,  as  promptly  as  pos- 
sible, tannin  being  added  to  the  water  which  is 
used  to  wash  the  stomach  after  evacuation.  Tea 
and  coffee  contain  tannin,  and,  since  they  are  al- 
most universally  available  in  emergencies,  their 
use  is  very  common.  Torald  Sollmann1  made  some 
experiments  to  determine  the  efficiency  of  infu- 
sions of  tea  and  coffee  as  precipitants  for  various 
alkaloids  and  metals,  and  found  the  infusion  of 
tea  much  the  more  active,  but  neither  of  them 
very  reliable  for  the  commonly  used  alkaloids, 
while  the  only  metals  for  which  tea  (infusion) 
would  be  useful  are  mercury,  lead  and  silver.  As 
a single  dose  of  lead  never  gives  rise  to  poisoning, 
and  as  poisoning  with  silver  salts  is  extremely 


1.  Journal  of  Medical  Research,  vol.  vli,  No.  1,  p.  43. 


ASTRINGENTS. 


143 


rare,  we  must  conclude  that  poisoning  with  mer- 
curic salts  is  practically  the  only  instance  likely  to 
be  encountered  in  which  tea  would  prove  to  be  an 
effective  precipitant.  The  use  of  tea  and  coffee  as 
stimulants  in  poisoning  depends  mainly  on  the 
caffein,  and,  of  course,  these  remarks  as  to  their 
limitations  do  not  apply  to  the  stimulant  use  of 
them. 

VEGETABLE  ASTRINGENTS. 

Acidum  Tannicum. — U.  S. — This  is  a light 
yellowish  amorphous  powder  of  a characteristic 
odor  and  a strongly  astringent  taste;  it  is  very 
soluble  in  water,  alcohol  or  glycerin. 

Average  dose:  0.5  gm.  (8  grains). 

Gltceritum  Acidi  Tannici. — U.  S. — A 20  per 
cent,  solution  of  tannic  acid  in  glycerin. 

Average  dose:  2 c.c.  (30  minims). 

Trochisci  Acidi  Tannici. — U.  S. — Each 

troche  contains  0.06  gm.  (1  grain)  of  tannic  acid 
with  sugar  and  tragacanth,  flavored  with  orange- 
flower  water. 

These  troches  are  used  almost  exclusively  in  af- 
fections of  the  mouth  and  throat. 

Gambir  (catechu),  kino,  krameria  and  many 
other  vegetable  drugs  contain  large  amounts  of 
their  peculiar  tannins,  together  with  mucilaginous 
and  other  extractive  matter  which  tends  to  pre- 
vent the  tannin  from  forming  compounds  in  the 
stomach  and  thus  preclude  its  action  on  the  mu- 
cous membrane  before  it  comes  into  the  intestine, 
hence  the  preparations  of  these  substances  are  more 
useful  in  the  treatment  of  diarrhea  than  are  pure 
tannin  and  its  preparations. 

Gambir. — TJ.  S. — Gambir  was  introduced  into 


144 


PHARMACOPEIA  AND  PHYSICIAN. 


the  present  Pharmacopeia  to  replace  catechu  of  the 
earlier  editions.  It  is  an  extract  prepared  from 
the  leaves  and  twigs  of  Ourouparia  Gambir  and  oc- 
curs in  irregular  masses,  varying  in  color  from 
reddish  brown  to  a pale  brownish  gray.  It  is  in- 
odorous, hut  has  a slightly  bitter,  .very  astringent 
taste,  with  a sweetish  after-taste. 

Average  dose:  1 gm.  (15  grains). 

Tinctura  Gambir  Composita. — IJ.  S. — This 
represents  5 per  cent.,  of  gambir  and  2.5  per  cent, 
of  Saigon  cinnamon  in  diluted  alcohol. 

Average  dose:  4 c.c.  (1  fluidrachm). 

Trochisci  Gambir. — U.  S. — Each  troche  con- 
tains 0.06  gm.  (1  grain)  of  gambir  with  sugar 
and  tragacanth,  flavored  with  orange-flower  water. 
These  troches  are  well  adapted  for  use  in  sore 
throat,  after  the  throat  has  been  sprayed  with  a 
solution  of  hydrogen  dioxid,  instead  of  the  as- 
tringent gargles  which  were  formerly  so  much  in 
vogue. 

Kino. — U.  S. — The  inspissated  juice  of  Ptero- 
carpus  marsupium  was  introduced  into  medicine 
by  Dr.  John  Fothergill  about  1757.  Like  Gambir, 
it  may  be  given  as  a powder,  preferably  combined 
with  opium  and  aromatics,  as  in  the  “Compound 
Kino  Powder”  K.  F. 

Average  dose  (of  kino)  : 0.5  gm.  (8  grains). 

Tinctura  Kino. — U.  S. — The  strength  of  this 
preparation  has  been  reduced  to  5 per  cent,  to 
obviate  its  tendency  to  gelatinize. 

Average  dose:  4 c.c.  (1  fluidrachm). 

The  following  prescription,  though  somewhat 
complex,  is  a slightly  modified  form  of  one  used  in 
certain  hospitals  with  satisfactory  results ; al- 
though the  chalk  is  alkaline,  it  does  not  apprecia- 


ASTRINGENTS. 


145 


bly  lessen  the  astringency  of  the  mixture,  as  do  the 
carbonates  of  the  alkalies  which  exist  in  the  in- 
testine. The  compound  tincture  of  gambir,  or  the 
tincture  of  krameria,  may  be  used  instead  of  the 
tincture  of  kino. 


R.  Cretae  preparatae  3i  4 

Tincturoe  kino  3iv  15 

Tincturse  opii  m.  v 3 

Spiritus  chloroformi  m.  lxxv  5 

Aquae  menthae  piperitae  3x  40 

Syrupi  aurantii  q.  s §iii  100 


For  children  of  from  '3  to  10  years  of  age,  from 
one-half  to  one  teaspoonful  of  this  mixture  may  be 
given  every  two  or  three  hours ; for  adults  the  dose 
is  one  tablespoonful. 

Another  combination  of  chalk  which  has  at- 
tained very  great  popularity  in  the  treatment  of 
diarrhea  is  the : 

Mtstitra  Cretai. — IJ.  S. — Chalk  Mixture  has 
the  following  composition : 


R.  Cretae  preparatae  gr.  xc  6 

Pulveris  acaciae  3i  4 

Pulveris  sacchari  gr.  cl  10 

Aquae  cinnamomi  3x  40 

Aquae  q.  s.  ad 3iii  100 


Average  dose:  15  c.c.  (4  fluidrachms). 

The  mixture  is  so  well  known  that  it  is  men- 
tioned merely  as  a reminder  of  one  of  our  best  and 
simplest  remedies  for  diarrhea.  It  is  peculiarly 
adapted  for  combating  the  diarrhea  of  children. 
Severe  cases  may  require  the  addition  of  a few 
drops  of  the  deodorized  tincture  of  opium  to  each 
adult  dose,  or  a corresponding  addition  of  pare- 
goric (the  camphorated  tincture  of  opium)  for 
children. 

The  vegetable  drugs  that  contain  tannin  are  so 
' numerous,  and  their  general  therapeutic  actions 


146 


PHARMACOPEIA  AND  PHYSICIAN. 


are  so  similar,  that  we  shall  merely  enumerate  the 
following  well-known  vegetable  astringents  and  the 
available,  official,  preparations : 

Eubus  (blackberry-root  bark) — Fluidextract 
and  Syrup. 

Eed  Eose — Fluidextract  and  Syrup. 

Geranium — Fluidextract. 

Hematoxylon — Extract. 

Ehus  Glabra — Fluidextract. 

Gallic  acid  is  sometimes  recommended  as  an 
astringent,  but  it  possesses  no  such  action  except 
that  of  any  very  weak  acid,  and  it  is  absolutely 
useless  for  hemorrhage  in  the  lungs,  kidneys  and 
other  regions  reached  only  by  the  circulation. 

Though  opium  does  not  contain  tannin,  it  would 
be  a distinct  omission  if  we  failed  to  mention  some 
of  its  indications  in  this  place,  since  this  work  is 
intended  primarily  to  call  attention  to  the  pos- 
sible therapeutic  uses  of  the  official  substances,  and 
since  the  arrangement  into  groups,  such  as  as- 
tringents, is  merely  for  convenience.  Small  doses 
of  any  of  the  opium  preparations  afford  one  of  the 
surest  means  of  relief  in  diarrhea.  They  are  com- 
monly combined  with  astringents,  inorganic  as 
well  as  organic,  with  excellent  results,  despite  the 
chemical  incompatibility  existing  between  the  alka- 
loids and  the  various  tannins  or  metallic  salts. 
The  preparations  of  opium  will  be  mentioned  in 
the  later  chapters,  and  we  now  merely  wish  to  call 
attention  to  methods  of  combining  these  agents. 


R.  Tinctura  gambir  composita  3i  301 

Tinctura  opii  deodoratae  m.  x 5 

Bismuthi  subnitratis  3iiss  10 1 

Aqua  camphora  q.  s Siii  100 1 


Sig. : One  teaspoonful  hourly  for  three  or  four  hours, 
then  every  two  or  three  hours. 


ASTRINGENTS. 


147 


Any  one  of  the  insoluble  bismuth  salts  may  be 
used,  and  tincture  of  kino  or  krameria  substituted 
for  the  compound  tincture  of  gambir.  Similarly, 
an  appropriate  amount  of  the  camphorated  tinc- 
ture of  opium  may  be  substituted  for  the  deodor- 
ized tincture.  When  it  is  desired  to  give  the  same 
active  ingredients  in  the  form  of  a dry  powder,  the 
following  may  be  used  : 


R.  Opii  pulveris  gr.  r |3 

Bismuthi  subnitratis  gr.  cl  10) 


M.  Ft.  pulvis  et  div.  in  chart,  x. 

Sig. : One  powder  to  be  given  every  two,  three  or 
four  hours,  according  to  the  needs  of  the  patient. 

Here,  again,  the  combination  may  be  varied 
almost  endlessly  by  using  one  of  the  other  in- 
soluble bismuth  salts,  the  deodorized  opium,  or 
by  adding  a small  proportion  of  one  of  the  veget- 
able astringents  like  kino  or  gambir. 

The  pill  of  lead  and  opium  is  well  adapted  for 
securing  a very  slowly  soluble  form  for  adminis- 
tering these  drugs.  The  pill  is  useful  in  diarrhea, 
but  must  not  be  long  continued,  lest  it  give  rise  to 
lead  poisoning. 

R.  Plumbi  acetatis  gr.  ii  |1 

Opii  pulveris  gr.  i j 05 

To  be  made  into  one  pill. 

Sig.:  One  pill  to  be  given  three  or  four  times  a day. 

Inflammation  of  the  stomach  and  intestine  and 
gastric  ulcer  may  be  treated  by  an  insoluble 
astringent  powder  which  not  only  relieves  conges- 
tion by  its  astringent  property,  but  also  forms  an 
insoluble  protective  covering,  preventing  the  con- 
tact of  irritating  particles  of  food  and  the  gastric 
and  intestinal  secretions,  besides  lessening  the 
amount  of  these  secretions. 


148 


PHARMACOPEIA  AX D PHYSICIAN. 


METALLIC  ASTRINGENTS. 

The  insoluble  salts  of  bismuth  are  admirably 
adapted  for  the  protection  of  the  intestinal  mu- 
cosa from  irritants  of  various  kinds.  While  as 
much  as  thirty  times  the  average  single  dose  of 
bismuth  salts  has  been  given  in  the  course  of  a day, 
by  the  mouth,  without  any  distinct  evidence  of  un- 
toward results,  absorption  and  poisoning  have  fol- 
lowed the  external  use  of  bismuth  salts  as  a dusting 
powder  when  used  over  a large  surface. 

Owing  to  the  extremly  poisonous  nature  of  bis- 
muth when  absorbed,  the  soluble  salts  seem  to  us 
to  be  entirely  superflous,  particularly  as  their  solu- 
bility precludes  the  very  object  for  which  bismuth 
compounds  are  chiefly  used — that  is,  for  the  me- 
chanical coating  of  the  surface  Avith  a protective 
layer  of  insoluble  powder.  It  must  be  admitted,  of 
course,  that  even  the  soluble  salts  of  bismuth  are 
astringent,  but  we  have  many  safer  astringents 
which  are  harmless  that  might  well  be  used  in 
their  stead. 

The  activity  of  the  nostrum-makers  has  resulted 
in  placing  on  the  market  a number  of  preparations 
that  are  intended  to  combine  the  antiseptic  proper- 
ties of  the  benzene  derivatives  with  the  astringent 
properties  of  bismuth,  but  until  we  know  more  of 
the  possibilities  and  the  limitations  of  internal  an- 
tiseptics it  is  preferable  to  use  the  simple  astrin- 
gents and  to  use  our  antiseptics  separately. 

Bismuth  subnitrate,  or  subcarbonate,  when  trit- 
urated with  water,  should  form  a creamy  mixture, 
and  the  physician  should  not  permit  the  use  of  that 
which  readily  separates  as  a heavy  powder,  leaving 
a nearly  clear  stratum  of  liquid  above  it.  The  coa-- 


ASTRINGENTS. 


149 


ering  power  of  bismuth  is  in  direct  proportion  to 
the  creaminess  of  the  mixture.2 

Bismuthi  Subnitras. — U.  S. — An  insoluble 
white  powder,  without  odor  or  taste. 

Bismuthi  Subcarbon'as. — U.  S. — Closely  re- 
sembles the  subnitrate. 

Average  dose  (of  either  salt)  : 0.5  gm.  (8 

grains ) . 

Bismuthi  Subsalicylas. — IT.  S. — This  prepar- 
ation closely  resembles  the  subnitrate  in  physical 
properties  and  is  intended  to  combine  the  anti- 
septic properties  of  the  salicylic  acid  with  the  as- 
tringency  of  bismuth  salts. 

Average  dose:  0.25  gm.  (4  grains). 

Bismuthi  Subgallas. — U.  S. — This  preparation 
was  at  one  time  widely  advertised  and  is  even  now 
occasionally  prescribed  by  its  proprietary  name, 
dermatol.  It  occurs  as  a bright  yellowish,  insol- 
uble, odorless  and  tasteless  powder,  which  is  mostly 
used  externally  as  a substitute  for  iodoform. 


2.  A typical  prescription  for  gastric  irritation,  or  ulcer 


is  as  follows  : 

Bismuthi  subnitratis grs.  cl  10 1 

Mucilaginis  acacia; 3xii  50] 

Aquae  cinnamomi  q.  s.  ad giii  100 1 


M.  Sig.  ; Shake  well  and  take  one  or  two  teaspoonfuls 
three  or  four  times  a day. 

In  cases  in  which  marked  irritability  persists,  the  addi- 
tion of  0.01  gm.  (1/6  grain)  of  cocain  hydrochlorid  to  each 
dose,  as  a local  anesthetic,  may  be  advantageous,  but  we  do 
not  advise'  it  as  a routine  procedure.  For  diarrhea  one  or 
two  drops  of  the  deodorized  tincture  of  opium  may  be  in- 
cluded for  each  dose,  or,  if  preferred,  tincture  of  opium.  For 
this  purpose,  it  is  usually  preferable  to  give  one  dose  every 
hour  for  three  or  four  doses,  then  every  two  to  four  hours  as 
needed.  Bismuth  subcarbonate  may  be  used  instead  of  the 
subnitrate  and  tincture  of  kino,  tincture  of  krameria  or  the 
compound  tincture  of  gambir  (catechu)  may  be  added  in 
the  treatment  of  diarrhea. 


150 


PHARMACOPEIA  AND  PHYSICIAN. 


Average  dose:  0.25  gm.  (4  grains). 

OFFICIAL  LEAD  SALTS. 

Lead  is  of  interest  chiefly  because  of  the  chronic 
lead  poisoning  so  often  encountered. 

The  principal  internal  use  of  lead  is  in  the  form 
of  the  pill  of  the  acetate,  usually  combined  with 
opium,  in  the  treatment  of  diarrhea.  It  has  also 
been  recommended  for  dysentery,  but  is  not  nearly 
so  useful  in  that  disease.  This  preparation  should 
not  'be  given  for  any  considerable  length  of  time, 
lest  it  give  rise  to  chronic  lead  poisoning.  The 
solution  of  lead  subacetate  is  unfit  for  internal 
administration,  but  is  of  value  in  painful  swell- 
ings and  local  inflammations  and  burns.  The 
well-known  mixture  of  laudanum  and  lead  water 
has  long  been  popular  as  an  external  application, 
but  any  mucilaginous  liquid  could  probably  be 
used  in  place  of  the  tincture  of  opium  without 
detriment,  since  the  astringency  of  the  lead  is  the 
main  factor,  the  local  application  of  the  opium 
alkaloids  being  entirely  superfluous  because  they 
are  not  absorbed  from  the  unbroken  skin.  The 
local  use  of  lead  water  itself  is  so  thoroughly  well 
established  that  it  scarcely  requires  further  com- 
ment.3 

Plumbi  Acetatis. — U.  S.— Acetate  of  Lead,  or 

3.  The  following  mixture  will  probably  answer  the  pur- 
poses for  which  laudanum  and  lead  water  are  commonly  used : 


R.  Liq.  plumbi  subacet min.  lxxv  5 

Mucil.  acac min.  xlv  3 

Aqua,  q.  s.  ad f.  giii  100 


The  solution  of  lead  subacetate  is  diluted  with  55  c.c.  (16 
fluid  drams)  of  water  and  the  mucilage  with  27  c.c.  (8 
fluid  drams)  the  two  are  then  mixed.  Fifteen  c.c.  (4 
fluid  drams)  of  alcohol  may  be  added  to  the  water,  but 
the  amount  of  alcohol  present  in  the  mixture  of  laudanum 
and  lead  water  is  too  small  to  be  of  any  benefit. 


ASTRINGENTS. 


151 


sugar  of  lead,  is  said  to  have  been  known  to  G-eber. 
It  was  described  by  Raymund  Lully  in  the  thir- 
teenth century,  but  was  not  used  in  medicine  until 
introduced  by  Goulard  a little  more  than  a century 
ago.  It  occurs  in  crystals  or  as  a heavy  white  pow- 
der, having  an  acetous  odor  and  a sweetish,  astrin- 
gent, afterward  metallic  taste. 

Average  dose:  0.05  gm.  (1  grain). 

Liquor  Plumbi  Subacetatis. — U.  S. — An 
aqueous  solution  containing  not  less  than  25  per 
cent,  of  lead  of  subacetate. 

Liquor  Plumbi  Subacetatis  Dilutus. — U.  S. 
— This  contains  about  1 per  cent,  of  lead  subacetate 
and  is  made  by  mixing  4 parts  of  the  solution  of 
lead  subacetate  with  96  parts  of  distilled  water. 

THE  LOCAL  TREATMENT  OF  MUCOUS  MEMBRANES. 

The  local  treatment  of  inflammation  of  the  mu- 
cous membranes  in  the  mouth,  nose,  throat,  vagina 
and  urethra,  after  thorough  cleansing,  preferably 
with  a solution  of  hydrogen  dioxid,  may  require 
mild  astringents  of  either  organic  or  inorganic  sub- 
stances, though,  as  previously  stated,  the  use  of  the 
solution  of  hydrogen  dioxid  has  greatly  lessened 
this  necessity.  Alum  has  long  enjoyed  a particular 
reputation  in  the  treatment  of  stomatitis,  and  has 
also  been  used  as  a gargle,  but  it  is  injurious  to  the 
teeth,  and  the  necessary  solution,  made  of  1 part  of 
alum  in  20  parts  of  water,  is  preferably  applied 
directly  to  the  affected  parts  by  means  of  a camel’s- 
hair  pencil  or  a swab  made  of  absorbent  cotton 
After  gargling,  the  mouth  should  be  rinsed  with 
water.  Alum  is  not  given  internally  so  often  as  it 
was  formerly;  it  is  irritating  and  possesses  no  ad- 
vantages over  other  astringents.  Because  of  this 


152 


PHARMACOPEIA  AM)  PHYSICIAN. 


irritant  action  it  is  emetic,  and,  while  not  very 
dependable,  may  serve  in  an  emergency  if  no  surer 
emetic  is  at  hand.  Small  ulcerations  of  the  throat, 
after  having  been  cleansed  with  an  antiseptic  so- 
lution, may  be  touched  with  a mixture  of  1 part 
of  ferric  subsulphate  and  2 parts  of  glycerin,  using 
a camel’sfhair  pencil  or  a cotton  swab. 

A very  large  number  of  astringent  gargles  are  in 
common  use,  but  the  following  is  a good  represen- 
tative of  the  class : 


R.  Tincturae 

ferri  chloridi  . . . 

. . . .m.  cl 

10 

Potassii 

chloratis  

3iii 

12 

Aquae  q. 

s 

f.  Bvi 

200 

Those  who  object  to  the  use  of  ferric  chlorid 
may  find  the  following  preferable : 

It.  Glyceriti  acidi  tannici  f.  3v  201 

Aquae  q.  s f.  §vi  200  j 

Alumen. — U.  S. — Alum  should  contain  not  less 
than  99.5  per  cent,  of  pure  aluminum  and  potas- 
sium sulphate.  It  occurs  as  colorless  crystals  or 
as  a white  powder;  it  is  odorless,  but  has  a sweet- 
ish and  strongly  astringent  taste.  Alum  is  soluble 
in  9 parts  of  water,  but  is  insoluble  in  alcohol. 

Average  dose:  0.5  gm.  (8  grains). 

Alumen  Exsiccatum.  — IT.  S.  — Popularly 
known  as  dried  alum,  must  contain  not  less  than 
99  per  cent,  of  anhydrous  aluminum  and  potas- 
sium sulphate.  It  is  used  for  the  same  purposes 
as  alum,  and  in  addition  is  somewhat  caustic  when 
dusted,  as  a dry  powder,  on  exuberant  growths. 

THE  USE  OF  ZINC  SALTS. 

Zinc  sulphate  and  zinc  phenolsulphonate  may  he 
considered  together;  they  have  a variety  of  appli- 
cations, and  it  is  only  necessary  to  suggest  the 


ASTRINGENTS. 


153 


strength  of  the  solutions  that  are  to  be  used  for 
various  purposes. 

For  the  eye  they  are  generally  used  in  the 
strength  of  from  one-fourth  to  one-half  of  1 per 
cent,  in  a solution  of  boric  acid,  to  which  camphor 
water  may  be  added. 

For  the  urethra  strong  solutions  should  not  be 
used,  one-half  of  1 per  cent,  in  water  being  suf- 
ficient. The  popular  combination  of  zinc  sulphate 
and  lead  acetate,  resulting  in  the  insoluble  lead 
sulphate  and  the  very  astringent  zinc  acetate,  may 
possess  some  advantages  over  the  more  simple  so- 
lution, but  they  are  not  very  apparent. 

Vaginal  douches  may  be  somewhat  stronger  and 
are  frequently  prescribed  of  from  1 to  2 per  cent, 
strength. 

As  noted  before,  all  the  astringents  may  act  as 
emetics  if  they  are  sufficiently  irritant  to  the  mu- 
cous membrane  of  the  stomach  and  are  not  caustic. 
Zinc  sulphate,  however,  deserves  the  preference 
among  the  astringents  used  as  emetics.  For  this 
purpose  it  is  usually  given  in  doses  of  1 or  2 gm. 
(15  to  30  grains  dissolved  in  a teacupful  of  warm 
water) . 

The  official  salts  of  zinc  that  are  of  interest  as 
astringents  are : 

Zinci  Sulphas. — TJ.  S. — Colorless  crystals, 
without  odor,  having  an  astringent  metallic  taste. 
Zinc  sulphate  is  soluble  in  less  than  1 part  of 
water,  but  is  insoluble  in  alcohol. 

Average  dose:  Emetic,  1 gm.  (15  grains). 

Zinci  Phenolsulphonate. — IJ.  S. — The  zinc 
sulphocarbolate  of  previous  editions  of  the  Phar- 
macopeia has  been  referred  to  under  antiseptics. 

Average  dose:  0.12  gm.  (2  grains). 


154 


PHARMACOPEIA  AND  PHYSICIAN. 


Zinci  Acetas.  — U.  S.  — This  constitutes  a 
widely  used  and  deservedly  popular  astringent. 

Average  dose:  0.12  gm.  (2  grains). 

Zinci  Oxidum. — U.  S. — A white  or  yellowish- 
white  powder,  insoluble  in  either  water  or  alcohol, 
it  is  largely  used  as  a local  application  in  dusting 
powders  and  in  ointments,  but  is  seldom  given  in- 
ternally. 

Average  dose:  0.25  gm.  (4  grains). 

COPPER  AND  IRON  SALTS. 

Cijpri  Sulphas. — U.  S. — Blue  stone  or  blue 
vitriol  was  known  to  the  Greeks  as  chalkanthos. 
Dioscorides  described  it  as  being  a valuable  astrin- 
gent and,  in  large  doses,  emetic.  It  occurs  as  deep 
blue  crystals  that  are  devoid  of  odor,  but  have 
a nauseous,  metallic  taste.  It  is  soluble  in  about  3 
parts  of  water. 

Average  dose  as  an  astringent:  0.01  gm.  (10 
mg.  or  1/5  grain); -as  an  emetic,  0.25  gm.  (4 
grains) . 

Of  the  numerous  preparations  of  iron  that  have 
astringent  properties  we  will  mention  but  one,  the 
chlorid,  as  representative  of  the  whole  class.  This 
is  official  in  several  forms : 

Ferri  Chloridum.  — U.  S.  — This  occurs  in 
orange-yellow  crystalline  pieces,  nearly  odorless, 
but  having  a strongly  styptic  taste. 

Average  dose:  0.05  gm.  (1  grain). 

Liquor  Ferri  Chloridi. — U.  S. — An  aqueous 
solution  of  ferric  chlorid,  containing  about  29  per 
cent,  of  the  anhydrous  salt. 

Average  dose:  0.1  c.c.  (1%  minims). 

This  preparation  is  but  little  used,  except  for 
preparing 

Tinctura  Ferri  Chloride — U.  S. — This  is 


ASTRINGENTS. 


155 


made  by  adding  35  parts  of  solution  of  ferric 
chlorid  to  enough  alcohol  to  make  100  c.c.  The 
official  tincture  is  directed  to  be  prepared  at  least 
three  months  before  being  used. 

Average  dose:  0.5  c.c.  (8  minims). 

This  preparation  is  injurious  to  the  teeth; 
therefore  it  should  be  directed  to  be  taken  through 
a tube  and  the  mouth  rinsed  with  water  or  a very 
mild  solution  of  an  alkali,  like  limewater. 

USE  OF  SILVER  NITRATE. 

Silver  nitrate  in  the  form  of  sticks,  lunar  caus- 
tic, is  mainly  used  as  a caustic  for  touching  warts 
of  various  kinds  and  for  non-granulating  wounds. 
A solution  of  silver  nitrate  is  sometimes  used  as  an 
application  to  the  conjunctiva,  followed  at  once 
by  a solution  of  sodium  chlorid,  whereby  a mo- 
mentary action  of  the  silver  nitrate  is  obtained,  the 
nitrate  being  instantly  converted  into  the  chlorid 
when  the  solution  of  sodium  chlorid  is  applied. 

Silver  in  combination  with  different  proteids 
has  been  introduced  under  a variety  of  trade- 
marked  or  proprietary  names  and  recommended 
as  a non-irritant  antiseptic,  mainly  for  the  treat- 
ment of  gonorrhea.  Crede  some  years  ago  intro- 
duced a soluble  form  of  metallic  silver,  for  which 
certain  manufacturers  make  the  fabulous  claim 
that  it  is  an  efficient  disinfectant  of  blood  and  tis- 
sue. So  long  as  septic  diseases  resist  all  treatment, 
it  seems  strange  that  reputable  manufacturers  will 
make  such  obvious  misstatements. 

The  only  official  preparation  of  silver  that  is  of 
direct  interest  in  connection  with  astringents  is 

Argenti  Nitras. — TJ.  S. — This  salt  is  supposed 
to  have  been  known  to  Geber,  but  was  introduced 


156 


PHARMACOPEIA  AND  PHYSICIAN. 


into  medicine  by  Angelus  Sala  during  the  seven- 
teenth century.  It  is  very  soluble  in  water  and  oc- 
curs as  colorless,  transparent,  tabular  crystals,  that 
darken  on  exposure  to  light  in  the  presence  of  or- 
ganic matter.  It  is  odorless,  but  has  a bitter,  caus- 
tic and  strongly  metallic  taste. 

Average  dose:  0.01  gm.  (10  gm.,  or  1/5  grain). 

The  internal  use  of  silver  nitrate  as  an  astrin- 
gent is  necessarily  empirical,  as  the  compound 
that  is  formed  when  silver  nitrate  is  brought 
into  contact  with  organic  matter  must  be  complex 
and  problematic.  A favorite  pill  of  the  late  Dr. 
William  Pepper  for  chronic  gastritis  was  the  fol- 
lowing. It  is  given  without  comment : 

II . Argenti  nitratis 

Extracti  hyoseyami 

Mannse,  aa gr.  1/3  [02 

To  make  one  pill. 

This  was  directed  to  be  given  three  or  four 
times  a day,  and  the  composition  was  occasionally 
varied  by  substituting  powdered  opium  for  the  ex- 
tract of  hyoscyamus. 

VASOCONSTRICTORS. 

In  addition  to  the  astringent  drugs  depending 
on  tannin  or  the  metallic  salts,  certain  alkaloids 
possess  a markedly  astringent,  or,  more  properly, 
vasoconstrictor  effect  when  applied  to  mucous 
membranes.  Of  these,  the  most  useful  are  hydr'as- 
tinin,  a derivative  of  hydrastin,  from  which  it  is 
obtained  by  oxidation,  and  the  alkaloid  of  the 
suprarenal  gland.  Here  we  are  compelled  to  admit 
that  this  latter  alkaloid,  which  is  now  being  mar- 
keted at  the  modest  price  of  some  $800  per  ounce, 
despite  Abel’s  simple  and  inexpensive  method  of 
preparation,  is  superior  to  the  official  desiccated 


ASTRTXGEXTS. 


157 


suprarenal  gland.  The  application  of  a 1 to  1,000 
solution  of  hydrastinin  or  a 1 to  5,000  solution  of 
the  suprarenal  alkaloid,  in  0.9  per  cent,  solution 
of  sodium  chlorid,  to  an  inflamed  conjunctiva  or 
inflamed  nasal  mucous  membrane  often  affords 
prompt  relief.  In  view  of  the  very  great  difference 
in  cost  without  a corresponding  difference  in  ef- 
fect, the  physician  can  well  afford  to  use  hydras- 
tinin in  preference  to  the  more  expensive  alkaloid 
in  such  conditions. 

The  desiccated  suprarenal  gland  may  be  mace- 
rated in  water  and  the  fluid  filtered  and  used,  but 
any  of  the  preparations  of  the  alkaloid  which 
appear  under  a variety  of  trade  names  will  usually 
be  preferred.  Slight  hemorrhages  are  also  stopped 
by  either  of  these  means. 

When  the  flow  of  blood  is  copious  and  hot  water 
is  ineffective,  styptics  are  useful;  they  are  not 
alone  astringent,  but  also  cause  a sudden  coagula- 
tion of  the  blood,  and  this  plugs  up  the  orifice. 
Large  clots  must  be  removed,  as  they  prevent  the 
immediate  contact  of  the  astringent  or  styptic  and 
may  conceal  a hemorrhage  occurring  in  cavities — 
the  uterus, ' for  instance — in  which  case  the  clot 
may  fill  the  upper  part  of  the  vagina. 

It  is  necessary  to  bear  in  mind  the  difference  be- 
tween the  action  of  vasoconstrictors,  like  the  alka- 
loid of  the  suprarenal  gland,  and  the  action  of 
styptics,  like  tannin  or  the  ferric  salts.  With  the 
former  the  action  is  transitory  and  the  hemorrhage 
may  recur  as  soon  as  the  action  of  the  drug  has 
worn  away,  while  styptics,  when  effective,  form  a 
plug  in  the  normal  distended  blood  vessel.  An- 
other point  to  be  remembered,  in  this  connection, 
is  the  fact  that  the  absorption  of  a vasoconstrictor, 


158 


PHARMACOPEIA  AX D PHYSICIAN. 


following  its  continued  or  too  liberal  use,  will 
cause  a general  rise  of  blood  pressure  and  thus 
actually  increase  the  flow  of  blood  at  the  bleeding 
points. 

Glandule  Suprarenales  Sicc^:. — IT.  S. — 
Desiccated  Suprarenal  Glands  are  directed  to  be  ob- 
tained from  the  sheep  or  os,  freed  from  fat, 
cleaned,  dried  and  powdered.  One  part  of  desic- 
cated suprarenal  gland  represents  approximately 
6 parts  of  fresh  glands  free  from  fat. 

Average  dose : 0.25  gm.  (4  grains) . 

The  alkaloid  contained  in  the  suprarenal  glands 
has  been  variously  designated  as  epinephrin  by 
Abel,  suprarenin  by  Fiirth  and  adrenalin  by  Taka- 
mine.  The  trade  names  that  are  now  applied  to 
the  solutions  of  the  same  substance  are  legion,  and 
it  seems  ver}r  unfortunate  indeed  that  the  commit- 
tee on  revision  of  the  Pharmacopeia  did  not  recog- 
nize the  alkaloidal  substance  in  an  official  way  and 
give  it  an  official  title.  The  only  effect  to  be  ex- 
pected from  the  internal  administration  of  the 
gland  or  its  alkaloid  is  the  local  constriction  that 
is  noticed  when  it  is  applied  to  the  mucous  mem- 
brane. The  solution  of  the  alkaloid  is  without  ef- 
fect on  blood  pressure  when  given  by  the  stomach 
and  when  injected  just  beneath  the  skin  it  pro- 
duces practically  no  effect,  except  a local  vasocon- 
striction. 


CHAPTER  VI. 


IRRITANTS,  EMOLLIENTS  AND  DEMUL- 
CENTS. 

There  are  so  many  substances  which  have  been 
used  as  irritants  under  varying  conditions  that  we 
can  not  attempt  to  do  more  than  mention  the  more 
useful  of  the  agents  frequently  employed  for  this 
purpose,  together  with  some  of  the  conditions  in 
which  clinical  experience  has  shown  them  to  be 
most  beneficial. 

While  the  employment  of  counter-irritants  is 
almost  wholly  empirical,  the  regions  of  the  skin 
which  Brunton  has  indicated  for  their  use  when  it 
is  desired  to  influence  the  internal  organs  corre- 
spond well  with  those  which  Head  has  shown  to 
exhibit  tenderness  of  the  skin  in  connection  with 
diseases  of  the  same  organs. 

Brunton  directs  the  irritant  to  be  placed  over 
the  larynx,  ovaries  or  sciatic  nerve  for  affections  of 
those  parts,  over  the  ensiform  cartilage  for  gastric 
disturbance,  above  and  below  the  knee  in  rheuma- 
tism, over  the  ball  of  the  great  toe  (dorsal  surface) 
in  gout,  behind  the  ear  in  facial  neuralgia,  at  the 
base  of  the  brain  and  back  of  the  neck  for  cerebral 
affections,  and  along  the  dorsal  region  of  the  back 
to  affect  the  uterus. 

The  mildest  of  irritants  is  water  or  saline  solu- 
tion used  as  a bath.  The  shock  of  the  cold  water 
applied  to  the  skin  and  the  slight  irritation  of  the 
subsequent  friction,  preferably  with  a coarse  towel, 
are  followed  by  a reaction  attended  with  a consid- 


] 60 


PHARMACOPEIA  AND  PHYSICIAN. 


erable  and  lasting  stimulation.  Very  cold  water 
may  produce  too  great  a shock  in  persons  who  are 
not  robust,  and  the  result  will  be  depression,  but 
there  can  be  little  doubt  that  baths  are  extremely 
beneficial  when  the  temperature  is  so  regulated 
that  a healthy  glow  and  a feeling  of  well-being 
succeed.  It  seems  that  the  question  of  the  useful- 
ness or  the  harm  of  cold  baths,  about  which  there 
has  been  so  much  contention,  resolves  itself  into  a 
question  of  individual  experience.  If  a feeling  of 
exhilaration,  but  no  subsequent  depression,  fol- 
lows the  bath  it  is  not  harmful ; if  no  such  exhila- 
ration occurs,  but  a distinct  depression  is  observed, 
there  can  be  but  little  doubt  that  the  bath  is  doing 
harm.  In  such  cases  a slight  increase  in  the  tem- 
perature of  the  water,  with  a shorter  time  and 
more  rubbing,  may  secure  the  benefits  sought.  The 
same  person  may  require  different  conditions  of 
temperature  at  different  times,  corresponding  to 
variations  in  the  general  health. 

A mixture  of  salts  is  sometimes  added  to  the 
bath  to  increase  the  slight  irritant  action. 

Even  milder  than  the  friction,  which  forms  so 
essential  a part  of  the  bath,  is  the  irritant  action 
of  the  astringents,  which  have  been  discussed  in 
Chapter  V,  but  these  are  followed  by  lessened  irri- 
tation, hence  they  are  not  considered  among  the 
irritants. 

RUBEFACIENTS. 

Rubefaction  is  the  result  of  a slight  irritation  of 
the  skin.  There  is  a slight  increase  in  the  exudate 
from  the  capillaries,  and  if  the  irritation  be  not 
long  continued  this  exudate  is  Teabsorbed  and  the 
part  speedily  returns  to  the  normal  condition. 


R U BE  FA  Cl  EX  TS. 


161 


While  all  irritants,  mild  and  caustic,  cause  rube- 
faction,  we  shall  first  consider  only  those  'which 
are  used  for  that  stage  alone,  and  take  up  the  vesi- 
cants, pustulants  and  caustics  later. 

ALCOHOL. 

Alcohol  alone,  diluted  with  water  or  in  the  form 
of  hamamelis  water,  alcoholic  tinctures,  spirits  or 
liniments,  is  used  more  frequently,  perhaps,  than 
any  other  mild  irritant,  with  the  possible  exception 
of  the  bath. 

Applications  containing  alcohol  are  useful  in 
painful  swellings,  bruises  and  a great  variety  Of 
minor  complaints  commonly  treated  in  the  house- 
hold without  calling  on  the  physician. 

While  it  is  probably  quite  unnecessary,  at  this 
late  date,  to  call  particular  attention  to  the  fact 
that  there  is  a distinct  and  a very  great  difference 
between  the  official,  or  ethyl,  alcohol  and  the 
various  forms  of  wood,  or  methyl,  alcohol,  never- 
theless the  insidiously  poisonous  properties  of  the 
latter  substance  do  not  appear  to  be  well  appre- 
ciated by  the  general  public.  The  number  of  cases 
of  blindness  and  of  death  that  have  been  reported 
by  Buller  and  Wood1  amply  demonstrate  that  even 
the  external  use  of  any  form  of  wood  alcohol  is 
not  entirely  free  from  danger  and  that  its  use  in 
any  form  of  medicinal  preparation  should  not  be 
countenanced  or  tolerated. 

Among  the  numerous  preparations  of  the 
United  States  Pharmacopeia  that  have  been  used 
as  topical  applications,  largely  because  of  the  rube- 


1.  The  Journal  A.  M.  A.,  Oct.  1,  8,  15,  22  and  29,  1904. 


162 


PHARMACOPEIA  AND  PHYSICIAN. 


facient  properties  of  the  alcohol  that  they  contain, 
we  may  enumerate : 

Aqua  Hamamelidis. — U.  S.- — This  preparation, 
more  popularly  known  as  extract  of  witchhazel,  or 
distilled  extract  of  witchhazel,  is  now,  for  the  first 
time,  included  in  the  Pharmacopeia.  While  the 
preparation  itself  has  been  known  for  many  years, 
and  has  been  used  extensively  as  a household  rem- 
edy, it  has  never  met  with  much  favor  on  the  part 
of  the  medical  profession.  The  official  prepara- 
tion is  directed  to  contain  15  per  cent,  of  alcohol 
and  should  be  free  from  methyl  alcohol  or  any  of 
its  derivatives. 

Tincture  Arnica. — U.  S.— Tincture  of  arnica 
represents  20  parts  of  the  dried  and  powdered 
flower  heads  of  Arnica  montana  in  diluted  alcohol. 
This  preparation  was  at  one  time  very  popular 
with  medical  practitioners  as  a topical  application 
in  so-called  “sprains”  and  in  bruises,  but  is  now 
seldom  employed.  The  same  is  true  of : 

Tincture  Calendula. — U.  S. — This  prepara- 
tion represents  20  per  cent,  of  the  dried  and 
powdered  florets  of  Calendula  officinalis,  the  well- 
known  marigold  of  our  gardens. 

Probably  the  most  objectionable  feature  in  con- 
nection with  the  use  of  any  of  the  official  tinctures 
as  topical  applications  is  their  tendency  to  stain. 
This  objection  is  largely  overcome  by  the  use  of 
the  simple  diluted  alcohol,  one  of  the  numerous 
unofficial  toilet  waters  or  colognes,  or  by  the  use 
of  one  or  the  other  of  the  official  spirits. 

In  addition  to  Spiritus  Frumenti. — U.  S. — 
Whisky,  and  Spiritus  Yini  Gallici. — U.  S. — 
Brandy,  the  most  frequently  used  of  this  class  of 
preparations  is : 


RUBEFACIENTS. 


163 


Spiritus  Camphors. — U.  S. — This  is  an  alco- 
holic solution  containing  10  per  cent,  of  camphor. 

Spiritus  Gaultherl®. — U.  S. — This  contains 
5 per  cent,  of  oil  of  gaultheria  in  alcohol. 

The  most  widely  used,  as  well  as  the  most  pop- 
ular, of  the  mildly  rubefacient  liniments  of  the 
Pharmacopeia  is : 

Linimentum  Saponis. — U.  S'. — Soap  Liniment 
is  variously  known  as  liquid  opodeldoc,  camphor- 
ated soap  liniment  and  camphorated  tincture  of 
soap.  It  contains  6 parts  of  soap,  4.5  parts  of  cam- 
phor, 1 part  of  oil  of  rosemary  and  72  parts  of 
alcohol  with  sufficient  water  to  make  100  parts. 
This  preparation  has  long  been  popular  as  a topical 
application  and  is  not  infrequently  used  as  a ve- 
hicle for  other  more  active  rubefacients,  sedatives 
and  anodynes. 

A somewdiat  typical  compound  liniment  is  the 

Liniment  Chloroformi. — U.  S.  — This  is  a 
simple  mixture  of  30  parts  of  chloroform  with  70 
parts  of  soap  liniment,  and  constitutes  a very  good 
illustration  of  the  possible  uses  of  soap  liniment  as 
a solvent  or  vehicle. 

CHLOROFORM. 

Chloroform  is  one  of  the  more  active  rube- 
facients and  the  action  quickly  passes  this  stage  if 
its  use  be  continued.  Chloroform  readily  dissolves 
fat,  and,  being  very  volatile,  it  penetrates  quickly 
and  causes  considerable  redness  and  pain.  A few 
drops  of  chloroform  placed  on  a little  absorbent 
cotton  and  applied  over  a painful  joint,  such  as  a 
bunion,  in  such  a way  that  evaporation  of  the 
chloroform  is  prevented,  causes  a good  deal  of  pain 
but  often  affords  speedy  relief.  It  should  not  be 


164 


PHARMACOPEIA  AND  PHYSICIAN. 


applied  in  this  way  for  longer  than  ten  or  fifteen 
minutes.  Chloroform  may  be  used  as  a counter- 
irritant  by  putting  a few  drops  on  cotton  in  a 
wide-mouthed  bottle;  the  mouth  of  the  bottle  is 
then  applied  to  the  area  to  be  treated,  for  a few 
minutes  at  a time. 

Chloroform  liniment,  noted  above,  is  much  less 
painful,  or  not  at  all  so  in  most  cases,  and  is  much 
slower  in  producing  its  effects.  Chloroform  lini- 
ment is  usually  directed  to  be  applied  to  the  af- 
fected part  by  being  thoroughly  rubbed  in,  thus 
securing  the  additional  rubefacient  action  of  fric- 
tion. It  may,  however,  be  more  economically  ap- 
plied, and  is  frequently  quite  as  effective,  if  di- 
rected to  be  put  on  cotton,  applied  to  the  affected 
surface  and  then  covered  with  several  layers  of 
cloth  or  otherwise  prevented  from  evaporating  too 
rapidly. 

VOLATILE  OILS. 

All  the  volatile  oils  are  irritant,  their  action 
ranging  from  that  of  the  mild  sandalwood  or 
copaiba  oil  to  the  extremely  irritant  volatile  oil  of 
mustard  or  even  the  caustic  action  of  oil  of  cloves. 
The  use  of  the  milder  members  of  this  series  for 
their  effects  on  the  urinary  tract  will  be  mentioned 
in  connection  with  diuretics.  Some  of  the  volatile 
oils,  such  as  pennyroyal  and  savin  oils,  which  are 
somewhat  more  irritant,  have  been  employed  to 
produce  abortion  by  reason  of  irritation  of  the  in- 
testine and  the  consequent  participation  in  the 
effects  by  the  uterus.  _ 

OFFICIAL  PREPARATION'S. 

Of  the  official  substances  that  are  more  or  less 


RUBEFACIENTS. 


165 


closely  connected  with  the  turpentine  group  and 
are  frequently  used  externally,  we  have : 

Oleum  Rosmarini.- — U.  S. — This  is  a volatile 
oil  distilled  from  the  fresh  flowering  tops  of  Ros- 
marinus officinalis  and  is  one  of  the  ingredients  in 
the  well-known  soap  liniment. 

Oleum  Sabinua — U.  S. — Oil  of  Savin  has  been 
quite  extensively  used  as  a local  irritant.  It  must 
be  used  with  caution  in  order  to  guard  against  the 
tendency  to  act  as  a vesicant. 

Oleum  Terebinthiius — U.  S. — Oil  of  Tur- 
pentine is  the  volatile  oil  distilled  from  turpen- 
tine. Even  as  an  external  application  it  is  not  in- 
frequently used  in  the  form  of 

Oleum  Terebinthinae  Bectificatum. — U.  S. 
— This  is  identical  with  oil  of  turpentine  in  chem- 
ical properties,  but  it  has  a more  agreeable  odor. 

Terebinti-iina. — U.  S. — This  is  officially  de- 
scribed as  the  concrete  oleoresin  of  Pinus  palustris 
and  of  other  species  of  Pinus. 

Resina. — U.  S. — Rosin,  resin  or  colophony  is 
the  residue  left  after  distilling  off  the  volatile  oil 
from  turpentine.  The  last  two  articles,  rosin  and 
turpentine,  are  interesting  only  as  constituents  of 
several  official  preparations,  of  which  the  best 
known  are : 

Ceratum  Resina. — U.  S. — This  is  a cerate 
containing  35  parts  of  rosin,  15  parts  of  yellow 
wax  and  50  parts  of  lard. 

Ceratum  Resinae  Compositum. — U.  S. — This 
is  a revival  of  the  one-time  official  Deshler’s  salve. 
It  contains  rosin,  yellow  wax,  prepared  suet,  tur- 
pentine and  linseed  oil. 

Linimentum  Terebinthin^:. — U.  S. — This  is 
a solution  of  65  parts  of  resin  cerate  in  35  parts 


166 


PHARMACOPEIA  AND  PHYSICIAN. 


of  oil  of  turpentine.  It  has  been  recommended  to 
be  used  in  place  of  the  oil  of  turpentine  as  a local 
application  when  the  action  of  the  latter  might  be 
considered  as  too  irritating. 

Oil  of  turpentine  may  be  applied  either  in  the 
form  of  the  official  liniment,  diluted  with  a fatty 
oil,  or  it  may  be  used  in  substance  as  a stupe;  the 
latter  is  made  by  saturating  a cloth  with  hot 
water,  wringing  it  out  and  then  dropping  on  it  a 
little  warm  oil  of  turpentine,  or  dipping  the  moist 
cloth  into  the  oil  of  turpentine  and  again  wring- 
ing it  out  and  applying  while  still  warm. 

Local  applications  of  this  kind  will  be  found 
useful  in  bronchitis.  Great  care  must  be  taken  in 
warming  oil  of  turpentine,  as  its  vapor  is  inflam- 
mable. It  should  be  warmed  by  placing  the  bottle 
containing  it,  uncorked,  in  a vessel  of  hot  water 
away  from  the  fire. 

Plasters  of  Burgundy  pitch,  Burgundy  pitch 
with  cantharides  and  of  resin  were  formerly  of- 
ficial. In  practice  these  old-time  resin  plasters 
have  long  since  been  replaced  by  the  more  modern 
rubber-base  plasters.  The  best  representative  of 
the  rubefacient  plasters  now  in  use  is  the 

Emplastrum  Capsici. — U.  S. — This  is  directed 
to  be  made  by  applying  a thin  coating  of  oleoresin 
of  capsicum  to  adhesive  plaster. 

CAPSICUM. 

Capsicum. — U.  S. — The  dried  ripe  fruit  of  Cap- 
sicum, fastigiatum  constitutes  one  of  the  most  pop- 
ular of  the  rubefacients  used  at  the  present  time. 
Of  the  available  official  preparations  we  have : 

Fluidextractum  Capsici. — V.  S.— This  is 
made  with  strong  alcohol. 


R UHEFACIEXTS. 


167 


Tixctura  Capsici. — U.  S. — This  is  made  with 
a mixture  of  95  parts  of  alcohol  with  5 parts  of 
water,  and  represents  10  per  cent,  of  the  crude 
drug. 

Either  of  these  preparations  may  be  used  diluted 
with  alcohol  or  with  soap  liniment  as  a local  rube- 
facient or  irritant. 

Oleoresixje  Capsici. — U.  S. — This  is  made  by 
extracting  capsicum  with  acetone  and  may  be  used 
in  the  shape  of  the  plaster,  as  noted  above,  or  in 
the  form  of  the  now  popular  mixture  with  pe- 
trolatum. 

A typical  prescription  for  a rubefacient  of  the 
latter  type  would  be  as  follows : 


R.  Oleoresini  capsici  gr.  xv  II 

Petrolati  giii  100] 


M.  Ft.  unguentum. 

Sig. : Use  locally. 

MENTHOL. 

Mexthol. — U.  S. — This  is  a secondary  alcohol 
obtained  from  the  oil  of  Mentha  piperita  or  other 
mint  oils.  This  substance  is  very  largely  used  in 
the  form  of  pencils  or  cones,  sometimes  in  alco- 
holic solution,  rubbed  on  the  skin  in  neuralgia. 
It  causes  a burning,  and  then  a sensation  of  cool- 
ness. 

Camphorated  Chloral. — IST.  F. — This  prepar- 
ation, cpiite  popular  in  some  parts  of  the  United 
States  as  a local  application,  consists  of  equal 
parts  of  hydrated  chloral  and  camphor.  It  is  a 
thick,  oily-looking  liquid,  which  is  extremely  irri- 
tating. It  may  be  diluted  with  the  fatty  oils,  al- 
cohol or  soap  liniment. 


168 


PHARMACOPEIA  AX D PHYSICIAN. 


MUSTARD. 

Mustard  is  official  as: 

Sinapis  Alba — IJ.  S. — White  Mustard  is  the 
seed  of  Sinapis  alia. 

Sinapis  Nigra. — XJ.  S. — Black  Mustard  is  the 
seed  of  Brassica  nigra. 

Oleum  Sinapis  Volatile. — U.  S. — This  is  a 
volatile  oil  obtained  from  black  mustard  (freed 
from  its  fatty  oil)  by  maceration  with  water  and 
subsequent  distillation. 

Ciiarta  Sinapis.— U.  S. — Mustard  Paper  is  di- 
rected to  be  made  by  coating  rather  thick,  well 
sized  paper  with  a mixture  of  rubber  cement  and 
powdered  black  mustard  which  has  been  deprived 
of  its  fatty  oil. 

Mustard  foot  baths,  containing  one  or  two 
ounces  of  powdered  or  ground  mustard,  prefer- 
ably the  black,  thoroughly  mixed  with  a gallon  of 
warm  water,  are  extremely  useful  for  the  relief  of 
mild  congestions  of  the  head  and  of  the  gastro- 
intestinal tract. 

Prompt  relief  is  often  obtained  in  this  way 
from  headache  and  from  pain  in  the  stomach.  In 
many  cases,  even  mild  attacks  of  indigestion  show 
decided  improvement  almost  immediately ; the 
action  is  further  accelerated  if  a liot-water  bag 
is  placed  over  the  region  of  the  stomach  at  the 
same  time. 

The  feet  should  be  placed  in  the  bath  while  the 
legs  and  feet  are  briskly  rubbed  with  the  mustard 
water  for  ten  minutes  or  until  the  skin  is  red  and 
some  irritation  is  felt.  The  extremities  are  then 
rubbed  dry  with  a coarse  towel  and  wrapped  in 
flannel  or  a blanket.  When  a slight  degree  of 


RUBEFACIENTS. 


169 


counter-irritation  is  desired  for  some  time,  a mus- 
tard poultice  is  employed.  This  is  made  by  mixing 
one  part  of  the  ground  black  mustard  with  about 
five  parts  of  flour  (or  ten  parts  of  flour  in  the  case 
of  children),  and  mixing  with  enough  water  to 
form  a mass.  This  is  then  spread  on  cheesecloth 
and  applied  at  once. 

Mustard  poultices  have  been  largely  replaced  by 
the  much  more  convenient  mustard  papers,  which 
are  dipped  in  tepid  water  and  applied  at  once. 
They  are  prone  to  become  worthless  in  damp  cli- 
mates, since  the  absorption  of  moisture  causes  the 
slow  development  of  the  volatile  oil,  which  then 
evaporates  as  fast  as  it  is  formed.  With  proper 
precaution,  however,  they  may  be  preserved  for  a 
considerable  length  of  time,  and  they  will  usually 
be  found  to  afford  the  most  convenient  means  of 
applying  counter-irritation. 

HEAT. 

The  uses  of  heat  are  so  numerous  and  so  well 
known  that  they  scarcely  require  further  mention 
at  this  time.  We  may  be  permitted  to  call  atten- 
tion, however,  to  some  of  the  various  forms  of 
cataplasms  or  poultices  that  are  frequently  used 
for  their  rubefacient  or  irritant  properties. 

Among  the  official  substances  that  are  frequently 
used  for  the  preparation  of  poultices  we  have : 

Linum. — U.  S. — Linseed  or  flaxseed  is  the  ripe 
seed  of  Linum  usiiatissimum. 

Ulmus. — U.  S.- — Elm  or  slippery  elm  is  the 
dried  bark  of  Ulmus  fulva,  deprived  of  its  peri- 
derm. 

Carbo  Ligeti. — U.  S. — This  is  charcoal  pre- 
pared from  soft  wood  and  powdered. 


170 


PHARMACOPEIA  AND  PHYSICIAN. 


Poultices  are  ordinarily  prepared  by  mixing  the 
requisite  amount  of  ground  flaxseed,  ground  elm 
bark  or  other  substance  with  enough  boiling  water 
to  make  a rather  stiff  mass,  inclosing  this  in  a piece 
of  gauze  or  muslin  and  applying  to  the  surface. 

The  rubefacient  properties  of  a poultice  may  be 
increased  by  the  addition  of  ground  mustard, 
tincture  of  capsicum  or  of  oil  of  turpentine.  For 
removing  fetor  or  to  act  as  disinfectants,  poultices 
may  have  added  to  them  powdered  charcoal,  chlor- 
inated lime  or  the  official  solution  of  chlorinated 
soda. 

The  present  edition  of  the  United  States  Phar- 
macopeia has  included  one  poultice,  as : 

Cataplasm  a Kaolixa. — U.  S. — This  consists 
of  kaolin,  glycerin  and  boric  acid,  with  thymol, 
methyl  salicylate  and  oil  of  peppermint  as  admix- 
ture to  give  it  a pleasing  odor.  This  preparation, 
like  other  poultices,  is  most  efficacious  when  ap- 
plied hot,  but,  as  its  action  depends  to  a very  great 
extent  on  the  r-ubefacient  properties  of  undiluted 
glycerin,  due  precaution  should  be  taken  to  pre- 
vent the  absorption  of  water  or  of  watery  vapor 
during  the  course  of  preparation  or  when  heating 
it  preparatory  to  applying. 

Practically  the  same  preparation  is  being  of- 
ferred  to  the  medical  profession  at  the  present 
time  under  a variety  of  trade  names,  and  while 
the  combination  undoubtedly  has  uses,  many  if 
not  all  of  the  positive  claims  that  are  made  in  con- 
nection with  it  are,  to  say  the  least,  somewhat  ex- 
aggerated, and  the  preparation  should  not  be  ex- 
pected to  accomplish  more  than  might  reasonably 
be  expected  from  an  equivalent  application  of  heat 
and  mild  rubefacients. 


RUBEFACIENTS. 


171 


One  other  point  in  connection  with  this  partic- 
ular preparation  that  has  been  the  cause  of  some 
controversy  in  the  advertising  pages  of  medical 
journals  is  the  question  of  priority.  This  question 
may  safely  be  ignored,  as  the  mixture,  apart  from 
the  flavoring  ingredients,  can  not  be  said  to  be 
new.  Glycerin  magmas  have  been  known  and  used 
for  upward  of  half  a century,  and  a formula  for 
practically  an  identical  preparation  may  be  found 
in  the  Pharmaceutical  Journal,  London,  for 
March.  1858. 

Formic  acid  has  long  been  known  and  used  in 
domestic  practice  as  a rubefacient.  In  Germany 
it  has  found  considerable  favor  in  regular  medicine 
and  is  official  in  the  German  Pharmacopeia  as  a 
24  per  cent,  solution  and  also  as  a spirit  of  formic- 
acid,  the  latter  containing  4 per  cent,  of  the  official 
solution  of  formic  acid  in  a mixture  of  alcohol  and 
water. 

IODIX. 

The  official  preparations  of  iodin  that  are  used 
as  rubefacients  are : 

Liquor  Iodi  Compositus. — LT.  S. — This  is  bet- 
ter known  as  Lugol’s  solution;  it  contains  5 per 
cent,  of  iodin  and  10  per  cent,  of  potassium  iodid 
in  water. 

Tinctura  Iodi. — LT.  S. — This  is  an  alcoholic 
solution  and  contains  7 per  cent,  of  iodin  and  5 per 
cent,  of  potassium  iodid. 

UxGUENTtJM  Iodi. — LT.  S. — This  contains  4 per 
cent,  of  iodin  and  4 per  cent,  of  potassium  iodid  in 
a mixture  of  glycerin  and  benzoinated  lard. 

Iodin  in  the  form  of  the  tincture  or  of  the  solu- 
tion is  very  commonly  applied  to  the  skin  as  a 


172 


PHARMACOPEIA  AND  PHYSICIAN. 


counter-irritant.  Repeated  applications  produce  a 
caustic  effect,  but  the  action  is  very  easily  con- 
trolled. One  great  disadvantage  possessed  by  the 
official  preparations  of  iodin  is  the  dark  staining 
of  the  skin.  Numerous  efforts  have  been  made  to 
obviate  this  by  using  so-called  colorless  tinctures  of 
iodin,  which  are  merely  solutions  of  iodids.  It  is 
much  better  to  apply  the  iodin  until  sufficient  irri- 
tation is  caused  and  then  remove  the  stain  by 
washing  with  dilute  solution  of  ammonia  water  or 
with  a solution  of  sodium  thiosulphate. 

A more  modern  preparation  of  iodin  that  prom- 
ises to  replace  the  official  preparations  as  an  ex- 
ternal application  is  a solution  of  iodin  in  sa- 
ponated  petrolatum,  a formula  for  which  will  be 
found  in  the  latest  edition  of  the  National  Formu- 
lary. 

Saponated  petrolatum  may  be  made  by  simply 
mixing : 


Liquid  petrolatum  3ii  60 

Oleic  acid  Si  30 

Spirit  of  ammonia  3ss  15 


In  the  order  enumerated,  the  only  necessary  pre- 
caution being  to  use  preparations  that  correspond 
to  the  requirements  of  the  United  States  Pharma- 
copeia. 

This  simple  saponated  petrolatum  will  readily 
dissolve  iodin  up  to  10  per  cent,  of  its  weight.  A 
5 or  6 per  cent,  solution  of  iodin,  however,  will  be 
found  to  be  most  useful  and  not  too  irritating. 

Probably  the  greatest  advantage  possessed  by 
a preparation  of  this  kind  is  due  to  the  fact  that  it 
causes  little  or  no  stain  and  may  be  readily  washed 
off  with  soap  and  warm  water. 

Saponated  petrolatum  may  also  be  used  for  ap- 


VESICANTS. 


173 


plying  a number  of  other  rubefacients,  such  as 
camphor,  menthol,  chloroform,  methyl  salicylate 
and  turpentine. 

VESICANTS. 

Vesication  is  the  result  of  greater  irritation  than 
that  which  merely  causes  rubefaction.  The  exu- 
date from  the  blood  vessels  is  not  absorbed,  but 
collects  beneath  the  horny  layer  of  the  skin,  which 
it  can  not  penetrate,  but  which  it  separates  from 
the  layers  beneath.  Such  collections  of  fluid  are 
called  vesicles  or  blisters,  and  the  agents  which 
produce  them  are  termed  epispastics,  vesicants  or 
‘^blisters.” 

If  the  vesicle  is  ruptured  soon  after  it  has 
formed,  and  the  horny  layer  removed,  it  leaves  a 
tender  surface  of  the  skin  exposed;  this  is  irri- 
tated even  by  contact  with  the  air,  and,  being  eas- 
ily permeated,  it  is  liable  to  infection,  hence  it  is 
better  to  puncture  the  blister  with  a sterile  needle 
inserted  at  the  periphery;  the  fluid  is  allowed  to 
escape  while  the  loose  layer  of  epidermis  is  left  in 
place  for  protection  until  a new  hard  layer  is 
formed. 

While  there  is  some  sensory  stimulation,  vesica- 
tion may  occur  from  slowly  acting  agents  which  do 
not  penetrate  readily,  with  merely  an  itching. 

Those  agents  which  applied  to  the  skin  cause 
vesication  also  cause  an  irritation  of  the  mucous 
membrane,  but,  as  the  exudate  escapes  more  read- 
ily from  such  surfaces  vesication  does  not  usually 
occur. 

ATsicants,  and,  in  fact,  all  but  the  mildest  of 
irritants,  such  as  heat,  are  contraindicted  in  the 
treatment  of  infants,  in  diabetics,  who  are  prone  to 
gangrene,  and  for  the  old  and  the  feeble. 


174 


PHARMACOPEIA  AND  PHYSICIAN. 


The  internal  use  of  irritants  which  are  excreted 
by  the  kidneys,  and  their  external  nse  if  they  are 
absorbed,  as  sometimes  occurs  with  cantharides, 
are  to  he  avoided  in  nephritis ; in  such  cases 
stronger  ammonia  water  may  be  used,  but  it  is 
very  painful. 

Mustard  occasions  so  much  pain  before  blister- 
ing, owing  to  the  volatility  of  the  oil  of  mustard, 
which,  therefore,  penetrates  readily,  that  it  is  sel- 
dom used  to  produce  an  irritation  beyond  the  stage 
of  rubefac-tion. 

Cantharides  contains  cantharidin,  which,  though 
readily  volatile  at  a higher  temperature,  is  not 
much  affected  at  the  body  temperature  and  does 
not  rapidly  penetrate  the  tissues,  hence  cantharides 
causes  vesication  with  but  little  pain  and  is  much 
the  most  popular  of  the  vesicating  agents. 

OFFICIAL  PREPARATIONS  OF  CANTHARIDES. 

Cantiiaris. — U.  S. — Cantharides,  more  popu- 
larly known  as  Spanish  flies,  is  officially  described 
as  the  thoroughly  dried  beetle  of  Cantharis  vesica- 
toria.  The  powder  of  cantharides,  which  is  the 
form  of  the  drug  that  is  most  frequently  found  in 
the  shops,  is  grayish  brown  in  color  with  shining 
green  particles.  It  should  contain  few  or  no  hairs. 

Ceratum  Cantharides. — IT.  S. — Cantharides 
Cerate,  also  known  as  blistering  cerate  or  blistering 
plaster,  contains  32  parts  of  powdered  cantharides 
in  a mixture  of  liquid  petrolatum,  yellow  wax, 
rosin  and  lard.  Cantharides  cerate  is  most  fre- 
quently  used  in  the  form  of  a plaster,  spread  on 
the  official  adhesive  plaster  or  some  other  suitable 
grease-proof  material. 

Collodium  Canthartdatum. — U.  S. — Can- 


VESICANTS. 


175 


tharidal  Collodion  represents  the  chloroform  sol- 
uble portion  of  60  parts  of  cantharides  dissolved 
in  sufficient  flexible  collodion  to  make  100  parts. 

Tinctura  Cantharides. — U.  S. — This  prepa- 
ration represents  10  parts  of  cantharides  extracted 
with  alcohol.  It  is  not  usually  efficient  as  a vesi- 
cant, but  is  frequently  used  externally  as  an  irri- 
tant or  rubefacient. 

The  active  principle  of  cantharides  is  not  soluble 
in  water,  and  as  the  normal  skin  is  usually  covered 
with  a thin  film  of  perspiration,  the  necessary  pre- 
cautions must  be  taken  to  have  the  blistering  prep- 
aration come  in  contact  with  the  dry  skin. 

This  is  most  readily  accomplished  by  washing 
the  part  with  soap  and  water  and  wiping  it  with  a 
small  amount  of  strong  alcohol.  In  the  case  of  the 
cerate  or  plaster  the  alcohol  may  be  followed  by  a 
fatty  oil,  or,  better  still,  the  surface  of  the  plaster 
may  be  thinly  coated  with  a coating  of  oil. 

In  directing  the  use  of  a blister  it  should  be  re- 
membered that  the  resulting  vesicle  is  usually 
larger  than  the  plaster  that  has  been  applied,  and 
the  size  of  the  latter,  therefore,  should  be  gauged 
accordingly. 

Cantharidal  collodion  is  simply  painted  on  the 
surface,  and  is  more  cleanly  than  the  cerate.  In 
using  blistering  collodion  the  same  precaution  of 
thoroughly  cleansing  the  skin,  with  soap  and  water, 
and  alcohol,  should  be  observed  so  as  to  insure 
vesication. 

Vesication  usually  ensues  in  about  six  hours 
after  the  application  of  the  vesicant,  but  a some- 
what longer  period  may  elapse  even  in  cases  in 
which  all  the  necessary  precautions  have  been  ob- 
served. and  the  physician  should  allow  ample  time 


176 


PHARMACOPEIA  AND  PHYSICIAN. 


before  he  concludes  that  the  preparation  is  worth- 
less. 

Oantharides  is  prone  to  deteriorate  with  age, 
and  one  is  often  inclined  to  attribute  the  failure  to 
cause  blistering,  to  the  worthlessness  of  the  pro- 
duct, but  even  a faultless  preparation  may  at 
times  fail  to  produce  vesication. 

The  now  widely  used  rubber-base  plaster  con- 
taining cantharides,  although  not  official,  has  many 
points  of  advantage  over  the  less  cleanly  extem- 
poraneous plaster  made  from  the  cerate.  After 
preparing  the  surface  of  the  skin,  as  indicated 
above,  the  plaster  is  smeared  over  with  a thin 
film  of  oil  and  applied  at  once.  After  causing 
sufficient  vesication  it  can  be  removed  readily,  and 
in  this  respect  offers  some  advantage  over  the 
blistering  collodoin  which  continues  to  act  until 
exhausted. 

While  cantharides  is  commonly  employed  as  a 
vesicant,  it  is  sometimes  applied  for  a shorter  time 
to  produce  rubefaction,  and  its  irritant  action  is 
also  made  use  of  in  hair  tonics,  as  it  is  supposed 
to  stimulate  the  growth  of  hair. 

The  following  formula  fairly  represents  the 
form  of  mixture  commonly  used  as  a hair  tonic : 


IJ.  Tinctura  cantharidis  f.3ii  81 

Ammonii  carbonatis  3i  4 

Spiritus  myrcise f.Sii  601 

Aquse  q.  s.  ad f.Svi  200 1 


M.  Sig. : Apply  with  brush,  rubbing  into  the  scalp  after 
washing  with  tar  soap. 

The  expensive  Packer’s  tar  soap  has  no  ad- 
vantage over  the  very  much  cheaper  tar  soap  gen- 
erally used  by  machinists  for  washing  grease  from 
the  hands. 


VESICANTS. 


177 


Where  an  oleaginous  preparation,  containing 
cantharides,  is  desired,  the  following  may  be  used: 


R.  Olei  ricini 

Tineturae  cantharidis,  aa f . 3ii  8 

Spiritus  myrciae  f.  gi  30 

Alcoholis  q.  s.  ad  f.  §vi  200 


M.  Sig.:  Apply  locally  to  scalp. 

The  toxicology  of  cantharides  is  of  some  im- 
portance because  the  laity  has  an  exaggerated  idea 
of  its  efficiency  as  an  aphrodisiac  without  a cor- 
responding appreciation  of  its  harmful  effects  on 
the  kidneys. 

Poison  oak  has  been  used  as  an  irritant,  but  it 
is  wholly  unsuited  for  the  purpose  because  of  the 
extraordinary  activity  of  the  irritant  principle, 
the  uncertainty  of  its  action,  and  the  inability  to 
control  it,  which  render  it  far  inferior  to  many 
other  available  irritants. 

It  is  of  much  greater  toxicologic  interest  because 
of  the  frequency  with  which  accidental  poisoning 
occurs,  either  from  handling  it  or  merely  coming 
into  the  immediate  neighborhood,  since  even  dust 
particles  may  carry  enough  of  the  extraordinarily 
active  fixed  oil,  toxicodendrol,  on  which  the  action 
depends,  to  poison  susceptible  persons. 

Toxicodendrol  penetrates  the  skin  very  easily 
and  is,  therefore,  difficult  to  remove.  Even  bland 
oils  are  to  be  avoided  in  the  treatment  of  poisoning 
by  it,  since  they  but  serve  to  dissolve  and  spread 
the  poison,  the  same  being  true,  of  course,  of  oint- 
ments, vaselin  and  cerates. 

In  treating  a case  of  rhus  poisoning  as  much  as 
possible  of  the  poison  should  be  removed  by  re- 
peated washing  with  soap  and  fresh  portions  of 
warm  water,  after  which  a paste  of  soap  or  a so- 


178 


PHARMACOPEIA  AND  PHYSICIAN. 


lution  of  lead  acetate  is  applied.  If  vesicles  form 
they  should  be  opened  with  care  and  the  liquid 
received  on  absorbent  cotton  or  a powder  such  as 
baking  soda,  since  it  would  but  extend  the  irrita- 
tion if  the  exuding  liquid  were  allowed  to  spread 
over  the  surface  of  the  skin. 

The  place  should  then  be  carefully  washed  with 
soap  and  warm  water  to  remove  even  traces  of  the 
fluid  from  the  vesicles,  and  the  soap  paste  or  the 
solution  of  lead  acetate  applied. 

Fluidextract  of  grindelia  robusta,  diluted  with 
water,  or  with  a saturated  solution  of  sodium  bi- 
carbonate (about  6 per  cent.)  has  had  a special 
reputation  as  a wash  for  the  treatment  of  poison 
oak. 

PUSTULANTS. 

Pustulants  are  those  irritants  which  give  rise  to 
pustules  instead  of  vesicles.  The  pustulants  ap- 
pear to  be  unable  to  affect  the  skin  through  the 
horny  layer  as  a rule,  but  can  only  penetrate  the 
orifices  of  the  glands.  They  are  much  less  fre- 
quently used  than  the  rubefacients  and  the  vesi- 
cants. 

As  tartar  emetic  is  not  irritant  except  in  acid 
solution  it  has  been  suggested  that  it  is  decom- 
posed by  acids  in  the  cutaneous  glands,  and  there 
produces  pustulation. 

Croton  oil  owes  its  irritant  action  to  crotonoleic 
acid,  which  exists  mainly  in  combination  as  a fat. 
This  fat  is  not  affected  by  the  gastric  juice,  but 
is  split  up  in  the  intestines  and  the  crotonoleic  acid 
is  then  able  to  exert  its  violent  irritation  result- 
ing in  purgation. 

Applied  to  the  skin  croton  oil  causes  pustula- 


PUSTULAXTS. 


179 


tion.  It  is  not  now  so  much  used  externally  or 
internally  as  it  was  formerly. 

OFFICIAL  PUSTULAjSTTS. 

Antimonii  Et  Potassii  Tartras. — IT.  S. — - 
Antimony  and  Potassium  Tartrate,  more  commonly 
known  as  tartar  emetic,  is  usually  seen  as  a white 
granular  powder,  without  odor,  and  having  a 
sweet,  afterward  disagreeable  metallic  taste.  It 
is  soluble  in  about  16  parts  of  cold  water,  but  is 
much  more  readily  soluble  in  hot  water. 

Antimony  and  potassium  tartrate  may  be  used 
externally,  as  a pustulant,  either  in  the  form  of 
the  powder,  in  aqueous  solution,  or  in  the  form  of 
an  ointment.  The  German  Pharmacopeia  contains 
a formula  for  the  latter  preparation  that  appears 
to  be  quite  popular  on  the  continent  of  Europe. 
This  is  a simple  mixture  of  20  parts  of  antimony 
and  potassium  tartrate,  with  80  parts  of  petrola- 
tum. 

Because  of  its  irritant  action  tartar  emetic  pro- 
duces nausea  or  emesis,  when  taken  internally,  ac- 
cording to  the  amount  employed.  It  is  much  more 
frequently  used  as  a nauseant  than  as  an  emetic, 
and  least  often  as  a pustulant;  for  the  latter  pur- 
pose it  will  be  found  to  be  preferable  to  use  it  in 
the  form  of  an  ointment,  similar  to  the  one  re- 
ferred to  above,  simply  rubbed  on  the  skin. 

Oleum  Tiglii. — U.  S. — Croton  oil  is  described 
as  a fixed  oil  expressed  from  Croton  Tiglium.  It 
occurs  as  a pale  yellow,  or  brownish  yellow  viscid, 
fluorescent  liquid,  having  a mild,  oily,  afterward 
acrid  and  burning  taste.  In  eastern  countries 
croton  oil  appears  to  have  been  known  from  a 
very  early  period.  It  was  known  in  Europe  sev- 


180 


PHARMACOPEIA  AND  PHYSICIAN. 


eral  centuries  ago,  but  fell  into  disuse  and  was 
reintroduced  there  with  several  other  drugs  from 
India,  about  1813. 

CAUSTICS. 

, Caustics  are  irritants  which  either  cause  violent 
inflammation,  resulting  in  necrosis,  or  dissolve 
the  tissue  by  direct  chemic  action. 

Caustics  may  be  used  to  produce  counterirrita- 
tion alone,  to  remove  exuberant  or  diseased  tissue, 
or,  in  diluted  form,  to  stimulate  non-granulating 
surfaces. 

Apart  from  the  use  of  the  thermo-cautery  in 
surgery,  that  of  lunar  caustic  for  exuberant 
growths  and  non-granulating  tissues,  and  of  ar- 
senic for  the  destruction  of  the  nerves  of  teeth, 
caustics  are  not  very  widely  used  at  the  present 
time. 

The  number  of  substances  possessing  a corrosive 
action  is  of  course  very  great,  but  many  of  them 
are  not  suited  for  therapeutic  use,  thus  the  strong 
alkalies,  such  as  caustic  potash  and  caustic  soda, 
dissolve  the  tissue  and  penetrate  deeply,  hence 
their  action  is  not  easily  controlled,  besides  they 
are  very  painful. 

Potassium  hydroxid,  better  known,  perhaps,  as 
potassa,  is  sometimes  used  to  soften  and  to  remove 
the  callous  of  corns  and  warts. 

The  action  of  silver  nitrate,  and  of  copper  sul- 
phate, in  the  form  of  molded  sticks,  or  cones,  is  so 
easily  controlled  that  they  are  very  commonly  used. 

Akgenti  Nitras. — XL  S. — Silver  Nitrate  ap- 
pears to  have  been  known  to  Geber  as  lapis  in- 
fernal] s in  the  eighth  century,  and  has  been  used 
extensivelv  since  that  time.  It  occurs  as  colorless 


CAUSTICS. 


181 


crystals,  which  are  freely  soluble  in  about  one 
part  of  water  and  melt  or  fuse  at  200°  C.  (392° 
F.).  This  latter  feature  is  taken  advantage  of  in 
making  the  official  forms  of  fused  silver  nitrate, 
and  is  also  of  advantage  in  forming  extemporane- 
ous preparations,  for  local  application,  by  melting 
or  fusing  silver  nitrate  on  to  suitable  metallic  in- 
struments such  as  sounds. 

Argenti  Nitras  Fusus. — U.  S. — Molded  Silver 
Witrate  contains  about  95  per  cent,  of  silver 
nitrate,-  with  a small  amount  of  silver  chlorid, 
which  is  added  to  make  the  sticks  tough  and 
fibrous. 

Argenti  TTitras  Mitigates  — U.  S. — Miti- 
gated Silver  Xitrate  is  composed  of  one  part  of  sil- 
ver nitrate  and  two  parts  of  potassium  nitrate 
fused  together. 

Cupri  Sulphas. — IT.  S. — Copper  Sulphate  or 
blue  vitriol  occurs  as  large,  transparent  deep  blue 
crystals.  For  external  use  these  crystals  may  be 
rasped  or  filed  into  suitable  shape,  and  are  then 
used  in  very  much  the  same  way  as  are  the  sticks 
of  silver  nitrate. 

The  various  uses  of  these  agents  are  so  well 
known  that  they  scarcely  require  extended  treat- 
ment here. 

When  the  lunar  caustic  is  used  on  exuberant 
granulations  care  should  be  taken  to  avoid  bring- 
ing it  into  contact  with  the  newly  formed  skin, 
which  is  recognized  only  as  a bluish  line,  since  this 
occasions  pain  and  is,  of  course,  destructive  of  the 
very  object  it  is  intended  to  promote. 

ARSENIC  AND  ZINC  CHLORID. 

Arseni  Trioxidum. — IT.  S. — Arsenic  Trioxid, 


182 


PHARMACOPEIA  AND  PHYSICIAN. 


also  known  as  arsenous  acid  and  as  white  arsenic, 
occurs  most  frequently  as  an  odorless,  and  taste- 
less white  powder,  that  is  but  slowly  soluble  in 
about  100  parts  of  water. 

Ziftci  Chlokidum. — U.  S. — Zinc  Chlorid  oc- 
curs as  a white  granular  powder  or  a porcelain- 
like mass.  It  is  freely  soluble  in  water,  but  the 
solution  decomposes,  on  long  standing  or  boiling, 
depositing  a basic  salt. 

Arsenic  and  zinc  chlorid  have  been  used  to  de- 
stroy cancerous  growths.  Arsenic,  particularly, 
has  been  widely  used  as  the  active  constituent  of 
various  cancer  cures  that  have  been  proposed  by 
regular,  as  wrell  as  irregular,  practitioners.  Its 
action  is  very  slow,  and  therefore  it  can  be  readily 
controlled,  but  it  occasions  considerable  pain. 
Arsenic  may  be  employed  in  the  form  of  powder, 
as  an  ointment,  either  with  lard  or  petrolatum, 
or  as  a paste.  In  the  latter  case  the  arsenic  is 
suitably  diluted  with  either  starch  or  powdered 
althaea,  and  subsequently  mixed  with  water  to 
which  a trace  of  gum  or  mucilage  has  been  added. 
At  present  arsenic  is  most  frequently  used  for 
the  destruction  of  the  nerves  in  carious  teeth. 

Zinc  chlorid  is  now  but  seldom  used  for  its  local 
corrosive  action.  It  may  be  used  in  aqueous  solu- 
tion or  fused  on  to  suitable  metallic  instruments, 
much  as  silver  nitrate  is  employed. 

Mercuric  chlorid  is  the  most  corrosive  of  the 
metallic  salts,  but  it  is  too  toxic  to  permit  of  its 
general  employment  for  its  local  caustic  action. 

SOME  OTHER  OFFICIAL  CAUSTICS. 

Acidum  ISTitricum.— U.  S. — The  official  Xitric- 
Acid  contains  G8  per  cent,  by  weight,  of  absolute 


EMOLLIENTS. 


183 


nitric  acid,  and  occurs  as  a colorless,  fuming  liquid 
that  is  very  caustic  and  corrosive. 

Liquor  Hydrargyri  ISTitratis.— U.  S. — Solu- 
tion of  Mercuric  Nitrate  occurs  as  a clear,  nearly 
colorless  liquid,  having  a faint  odor  of  nitric  acid 
and  a strongly  acid  reaction.  It  should  contain 
about  60  per  cent,  of  mercuric  nitrate  and  about 
11  per  cent,  of  free  nitric  acid. 

Unguentum  Hydrargyri  Nitratis — U.  S. — 
Ointment  of  Mercuric  Nitrate  is  made  by  dissolv- 
ing 7 parts  of  mererny  in  10.5  parts  of  nitric  acid 
and  adding  this  solution  to  76  parts  of  lard  that 
has  previously  been  partially  decomposed  by  7 
parts  of  nitric  acid,  and  continuing  the  heat,  if 
necessary,  until  the  reaction  is  completed.  The  re- 
sulting ointment  should  have  a bright  yellow  color, 
whence  its  popular  name,  “citrine  ointment.” 

Unguenttjm  Hydrargyri  Ammoniati. — IT. 
S. — The  Ointment  of  Ammoniated  Mercury  is 
now  directed  to  be  made  by  mixing  10  parts  of  am- 
moniated mercury  with  50  parts  of  white  petro- 
latum and  40  parts  of  hydrous  wool  fat. 

Nitric  acid  is  a popular  domestic  remedy  for 
the  removal  of  warts.  The  surrounding  surface 
should  be  thickly  covered  with  petrolatum  and  a 
single  drop  at  a time  of  the  acid  applied  to  the 
excresenee. 

EMOLLIENTS. 

The  word  emollient  is  derived  from  emollio , to 
soften ; demulcent  comes  from  demulceo , to 
smooth.  Since  the  same  agent  is  usually  demulcent 
as  well  as  emollient,  the  term  to  be  used  depends 
on  the  tissue  to  which  the  agent  is  to  be  applied, 
rather  than  on  the  medicinal  agent  itself.  Mucous 


184 


PHARMACOPEIA  AND  PHYSICIAN. 


membranes  rarely  require  softening,  but  an  in- 
flamed skin  is  frequently  hard  and  rough,  we 
therefore  speak  of  applying  demulcents  to  mucous 
membranes  and  emollients  to  the  skin. 

Not  only  bland  oily  substances  and  fats,  but 
mucilages  and  diluted  glycerin  act  as  emollients. 
Glycerin,  when  diluted  with  water,  and  rubbed 
into  the  skin,  prevents  it  from  becoming  dry  and 
harsh,  and  the  tendency  to  crack.  Oils  and  fats 
penetrate  the  skin  and  render  it  soft. 

SOME  OFFICIAL  EMOLLIENTS. 

Adeps  Lan^e  IIydrosus. — U.  S. — This  prepara- 
tion, formerly  called  lanolin,  is  the  purified  fat  of 
the  wool  of  sheep  (Ovis  dries),  mixed  with  about 
30  per  cent,  of  water. 

Glycerinum.- — U.  S. — Glycerin  or  glycerol  is  a 
clear  colorless  liquid  of  syrupy  consistence,  .ob- 
tained by  the  decomposition  of  vegetable  or  animal 
fats.  Anhydrous  glycerin  is  slightly  rubefacient, 
but  when  diluted,  as  noted  above,  is  an  efficient 
emollient. 

Mucilago  Tragacanthle. — II.  S. — Mucilage 
of  Tragacanth  contains  6 per  cent,  of  tragacanth 
and  18  per  cent,  of  glycerin,  with  enough  water  to 
make  100  parts. 

Petrolatum. — U.  S.- — Under  this  general  head- 
ing the  present  Pharmacopeia  includes  what  was 
formerly  known  as  hard  and  soft  petrolatum. 

Petrolatum,  a mixture  of  hvdrocarbons,  of  the 

V.:  GO  . . r 

methane  series,  is  obtained  from  petroleum  and 
should  be  of  about  the  consistence  of  an  ointment. 
The  official  substance  may  vary  in  color  from  yel- 
low to  light  amber  and  have  a melting  point  vary- 
ing from  45°  to  48°  C.  (113°  to  11S.4°  F.).  in 


EMOLLIENTS. 


185' 


addition  to  this,  which  is  popularly  known  as  yel- 
low petrolatum,  the  Pharmacopeia  also  includes : 

Petrolatum  Album. — U.  S.— This  is  a white 
unctious  mass,  of  about  the  consistence  of  oint- 
ment, that  otherwise  has  the  same  chemical  and 
physical  characteristics  as  petrolatum. 

Petrolatum  Liquidum. — TJ.  S. — Liquid  Petro- 
latum is  a colorless  or  only  slightly  yellowish,  oily 
transparent  liquid  without  odor  or  taste,  but  giv- 
ing off.  when  heated,  a slight  odor  of  petrolatum. 

Of  the  vegetable  oils  that  are  useful  as  demul- 
cents, it  will  suffice  to  enumerate : 

Oleum  Amygdala  Expressum. — U.  S. — Ex- 
pressed Oil  of  Almonds. 

Oleum  Gossypii  Seminis. — TJ.  S. — Cotton  Seed 
Oil. 

Oleum  Olhle. — TJ.  S. — Olive  Oil. 

Oleum  Theobromatis.— TJ.  S.- — Oil  of  Theo- 
broma,  so-called  “cocoa”  butter. 

Of  the  several  official  preparations  of  this  class 
by  far  the  most  popular  is : 

TJnguentum  Aqu^e  Rosm:. — TJ.  S. — Ointment 
of  Rose  Water,  or,  as  it  is  usually  called,  cold  cream. 
This  ointment  consists  of  a mixture  of  spermaceti, 
white  wmx,  expressed  oil  of  almonds,  sodium 
borate  and  rose  water,  and  in  one  form  or  another 
has  been  the  most  popular  of  the  mild  emollients 
from  the  time  of  its  originator,  Galen. 

Emollients  are  used  for  the  protection  of  in- 
flamed skin  against  irritants,  the  choice  depending 
on  individual  preference  or  convenience  rather 
than  on  the  nature  of  the  drug.  Thus  mucilage  of 
tragacanth,  ointment  of  rose  water  and  petrolatum 
differ  widely  in  their  physical  properties,  but  they 


186 


PHARMACOPEIA  AX D PHYSICIAN. 


are  all  used  for  chapped  hands,  sunburn,  and  to 
soften  the  skin  when  it  is  rough  and  hard. 

The  bland  oils  and  ointments  penetrate  the  skin 
more  readily  than  does  diluted  glycerin,  and, 
therefore,  they  are  to  be  preferred  as  emollients 
when  they  are  also  to  serve  as  carriers  of  medicinal 
substances  intended  for  absorption. 

Diluted  glycerin  is  an  excellent  agent  for  soft- 
ening the  skin,  but  is  somewhat  irritant,  and  when 
the  sensitive  layers  of  the  skin  are  exposed,  a bland 
oil  or  ointment,  such  as  cold  cream,  is  to  be  pre- 
ferred. 

To  prevent  chapping  of  the  skin  when  it  is  ex- 
posed to  the  wind,  to  alternate  wetting  and  drying, 
or  to  irritants,  the  mucilage  of  tragacanth,  pre- 
ferably mixed  with  an  equal  portion  of  glycerin, 
will  be  found  useful.  The  exposed  surface  is 
washed  with  warm  water  and  soap  to  soften  the 
skin,  and  while  it  is  still  moist,  but  not  wet,  a 
little  of  the  mucilage,  or  the  mixture  of  mucilage 
and  glycerin,  is  rubbed  into  the  surface  until  the 
latter  feels  smooth.  Instead  of  the  tragacanth 
mixture  the  following  may  be  preferred  by  some, 
but  it  is  somewhat  irritant  to  very  delicate  skin : 

One  ounce  of  glycerin  soap  is  reduced  to  shav- 
ings and  dissolved  with  the  aid  of  gentle  heat,  in 
half  a pint  of  a mixture  of  equal  parts  of  glycerin 
and  water.  This  mixture  solidifies  on  cooling,  and 
a piece  about  twice  the  size  of  a pea  is  to  be  rubbed 
into  the  moist  skin  as  often  as  may  be  necessary. 
Those  who  work  with  irritant  or  corrosive  chemi- 
cals will  find  this  an  excellent  agent  for  keeping 
the  hands  soft. 

A liquid  preparation  that  has  met  with  consid- 
erable favor  may  be  made  by  mixing  ten  parts  of 


EMOLLIENTS. 


187 


tincture  of  benzoin,  fifty  parts  of  water,  and  forty 
parts  of  glycerin.  To  secure  a homogeneous  mix- 
ture the  water  should  be  gradually  added  to  the 
tincture  of  benzoin,  and  the  glycerin  added  to  this 
mixture.  If  the  resulting  mixture  should  still  be 
irritating  the  amount  of  glycerin  may  be  further 
reduced,  with  a corresponding  increase  in  the 
quantity  of  the  water.  If  rose  water  were  substi- 
tuted for  the  water  in  the  above  formula  the  re- 
sulting mixture  would  simulate  some  of  the  well 
known  and  widely  advertised  proprietary  toilet 
preparations  of  glycerin  and  roses. 


CHAPTER  VII. 


LOCAL  ANESTHETICS  AND  ANODYNES. 

The  introduction  of  cocain  marked  a decided  ad- 
vance in  the  production  of  local  anesthesia. 

Previous  to  that,  freezing  the  part  by  immersion 
in  a mixture  of  salt  and  snow,  or  shaved  ice,  or  by 
spraying  with  ether  or  other  volatile  liquid,  was 
used,  and  while  a procedure  of  this  kind  does  pro-, 
duce  complete  anesthesia,  the  pain  experienced 
during  the  freezing  and  thawing  greatly  exceeds 
that  which  would  be  caused  by  such  a simple 
operation  as  opening  an  abscess  or  the  removal  of 
a small  foreign  body,  such  as  a splinter  or  piece  of 
glass,  when  readily  accessible.  It  is  because  of  the 
inherent  dread  which  the  average  person  has  of 
the  surgeon’s  knife,  that  he  will  undergo  suffering 
akin  to  that  with  which  he  is  familiar,  rather  than 
endure  a lesser  one  which  seems  dreadful  because 
it  is  unfamiliar. 

It  is  also  true  that  the  injection  of  cocain  some- 
times causes  more  pain  than  would  the  operation 
for  which  it  is  given,  and,  since  surgical  operations 
have  become  so  much  more  common  than  they  were 
formerly,  many  adults  willingly  bear  the  brief, 
sharp  pain  of  a simple  incision,  rather  than  resort 
to  cocain,  which  has  come  into  a certain  disrepute 
because  of  the  abuse  of  it  by  its  victims,  the  ma- 
jority of  whom  have  become  such  through  the  use 
of  supposedly  harmless  nostrums  pretending  to  be 
valuable  remedies  for  hay  fever  and  other  minor 
affections. 


LOCAL  ANESTHETICS. 


189 


Cocain,  which  is  benzoyl  ecgonin,  shows  a cer- 
tain chemical  analogy  to  atropin  and  aconifin, 
which  resemble  it  somewhat  in  their  action  on 
sensory  nerves,  and  it  is  also  related  to  phenol 
through  the  benzoyl  group,  since  benzoic  acid  dif- 
fers from  phenol  only  by  having  a COOH  group  in 
place  of  the  OH  of  the  phenol.  The  anesthetic 
action  of  phenol  is  second  only  to  that  of  cocain. 

Aside  from  the  systemic  effect,  which  we  need 
not  fully  detail  here,  cocain  paralyzes  sensory  nerve 
endings  with  which  it  comes  in  contact  and  even 
nerve  trunks  when  in  sufficient  concentration;  if 
the  solution  is  sufficiently  dilute  and  the  action  not 
too  long  continued,  the  nerve  endings  rapidly  re- 
turn to  normal  (the  nerve  trunk  more  slowly), 
when  the  application  is  discontinued  and  the  co- 
cain removed  by  absorption  into  the  general  circu- 
lation, or  evacuated. 

When  a fairly  strong  solution  (3  per  cent.)  is 
injected  into  the  area  about  a nerve  trunk,  or  an 
even  weaker  solution,  2 per  cent.,  within  the  nerve 
sheath,  both  sensory  and  motor  paralysis  occur  in 
about  fifteen  minutes,  affecting,  of  course,  the  en- 
tire distribution  of  the  nerve,  the  effect  lasting  for 
some  hours  after  intraneural  injection. 

Since  aqueous  solutions  are  not  absorbed  from 
the  unbroken  skin,  they  must  be  injected  beneath 
the  epidermis,  at  least,  in  order  that  they  may 
come  into  actual  contact  with  the  nerve  ends. 

When  the  solution  is  injected  deeply  into  the 
muscular  tissue  the  greater  part  of  it  passes  into 
the  general  circulation  and  is  lost  so  far  as  local 
action  is  concerned.  To  avoid  this,  it  is  better  to 
inject  the  solution  between  the  layers  of  the  skin, 
at  the  same  time  limiting  the  circulation  in  the 


190 


PHARMACOPEIA  AND  PHYSICIAN. 


part  as  much  as  possible  by  compressing  the  blood 
vessels,  preferably  with  a rubber  band  or  other 
tight  bandage. 

Practically,  the  same  object  may  be  achieved  by 
the  use  of  a solution  of  the  alkaloid  of  the  supra- 
renal gland  immediately  preceding  the  injection  of 
the  solution  of  cocain.  The  injection  of  the  solu- 
tion of  suprarenal  alkaloid  (epinephrin,  adrenalin 
or  one  of  the  other  trade  preparations)  causes  a 
local  vasoconstriction  that  in  turn  prevents  the 
rapid  absorption  of  the  cocain  solution  into  the 
general  circulation,  and  also  prevents,  for  the  time 
being,  the  excessive  hemorrhage  that  is  so  objec- 
tionable in  minor  operations.  When  it  is  neces- 
sary for  the  solution  of  cocain  to  diffuse  through 
a part,  a moment  should  elapse  after  the  injection 
before  applying  the  constricting  bandage. 

The  combined  use  of  suprarenal  alkaloid  and 
of  cocain  has  proved  to  be  of  particular  advantage 
in  the  eye  and  in  the  nose.  One  reason,  and  prob- 
ably the  most  weighty  one,  is  to  be  found  in  the 
fact  that  normal  mucous  surfaces  have  a tendency 
to  absorb  cocain  verjr  rapidly. 

When  cocain  is  applied  to  mucous  membranes, 
either  in  powder  or  in  solution,  it  causes  its  local 
effects  for  a short  time  and  is  then  absorbed,  pro- 
ducing its  systemic  action.  Herein  lies  one  of  the 
chief  sources  of  danger  of  the  many  so-called  hay- 
fever  remedies,  which  virtually  consist  of  cocain 
with  some  diluent  powder,  such  as  sugar  of  milk, 
and  are  intended  to  induce  and  to  continue  the 
truly  terrible  cocain  habit. 

Owing  to  the  brief  action  and  rapid  absorption, 
frequent  repetition  is  necessary  to  secure  relief  in 
“colds”  and  the  user  is  peculiarly  liable  to  become 


LOCAL  ANESTHETICS. 


191 


addicted  to  the  habit  which,  in  its  baneful  effects, 
is  not  exceeded  perhaps,  in  the  whole  range  of 
drug  addiction,  not  even  excepting  alcoholism.  As 
a matter  of  fact,  many  of  the  so-called  hay-fever 
nostrums  are  intended  primarily  for  supplying 
those  who  are  already  victims  of  the  habit  and  who 
would  find  difficulty  in  buying  the  drug  under  its 
real  name.  This  practice  may  be  said  to  consti- 
tute a disgraceful  example  of  the  lack  of  control 
of  the  nefarious  nostrum  traffic  by  the  law. 

We  should  be  particularly  careful  to  warn 
patients  and  others  against  the  insidiousness  of 
this  type  of  self  medication  that  our  skirts  may  at 
least  be  kept  clean  in  connection  with  this  one 
phase  of  the  evil. 

Cocain  in  solution  is  readily  decomposed  on 
boiling,  but  if  the  solution  be  made  with  sterile, 
cold  water  there  will  be  little  cause  to  anticipate 
sepsis  from  its  injection  with  the  usual  precau- 
tions. The  solution  may  be  sterilized,  however, 
by  heating  to  80°  C.  (176°  F.)  for  half  an  hour  at 
a time  on  two  successive  days,  care  being  taken  to 
eliminate  all  possible  contaminations  of  even  a 
trace  of  alkali. 

Eucain  and  stovain  have  the  advantage  of  resist- 
ing decomposition  by  boiling,  but,  as  just  sug- 
gested, the  disadvantage  possessed  by  cocain  is 
more  apparent  than  real,  and  the  general  action  of 
cocain,  particularly  its  possible  complications, 
being  well  known,  that  drug,  no  doubt,  will  con- 
tinue to  hold  first  place  as  a local  anesthetic,  ex- 
cept where  the  ubiquitous  detail  man  succeeds  in 
frightening  the  more  timid  members  of  the  profes- 
sion into  an  exaggerated  idea  of  the  various  dangers 
attending  the  proper  use  of  the  official  article,  and 


192 


PHARMACOPEIA  AND  PHYSICIAN. 


into  a corresponding  credulousness  concerning  the 
entire  harmlessness  of  the  particular  substitute  in 
which  he  is  interested. 

Cocain,  when  dropped  into  the  eye,  or  taken  in- 
ternally, causes  an  incomplete  dilatation  of  the 
pupil  by  stimulating  the  sympathetic  nerve,  reac- 
tion to  light  being  maintained,  differing  therein 
from  atropin,  which  abolishes  this  reflex. 

OFFICIAL  PREPARATIONS  OF  COCAIN. 

Cocaine  Hydrochloriduai. — II.  S. — Cocain 
Hydrochlorid,  the  most  widely  used  preparation  of 
cocain.  is  officially  described  as  the  neutral  hydro- 
chlorid of  an  alkaloid  obtained  from  several  vari- 
ties  of  coca.  It  occurs  as  colorless,  transparent 
crystals  or  a white  crystalline  powder.  It  is  soluble 
in  less  than  one  part  of  cold  water  and  in  2.6  parts 
of  alcohol,  but  is  insoluble  in  petroleum  benzin 
and  in  ether. 

Cocain. — U.  S. — This  is  an  alkaloid  obtained 
from  several  varieties  of  coca,  resembling  cocain 
hydrochlorid  in  many  of  its  properties,  but  being 
only  slightly  (1-600)  soluble  in  water.  It  is  soluble 
in  5 parts  of  alcohol  and  even  more  soluble  in 
ether  and  in  petroleum  benzin.  The  alkaloid  co- 
cain is  also  soluble  in  about  12  parts  of  olive  oil 
and  it,  or  the  oleate,  is  to  be  used  in  making  solu- 
tions of  cocain  in  oil.  • 

Oleatum  Cocaine. — U.  S. — Oleate  of  Cocain 
contains  5 per  cent,  by  weight  of  cocain  in  a mix- 
ture of  oleic  acid  and  olive  oil. 

The  liquid  preparations  of  coca,  the  fluid  extract 
and  the  wine,  are  never  used  externally,  although, 
if  applied  to  the  mucous  surfaces,  or  to  the  abraded 
skin,  their  use  would  not  be  devoid  of  danger,  from 


LOCAL  ANESTHETICS. 


193 


the  absorption  of  the  contained  cocain,  and  other 
coca  alkaloids. 

Cocain  is  used  locally  on  mucous  membranes  to 
allay  irritation  and  inflammation  as  in  hay  fever, 
but  it  should  be  used  very  guardedly  and  not  be 
too  long  continued.  It  is  very  much  less  useful  in 
this  condition  than  was  formerly  supposed  and  it 
has  been  very  largely  replaced  by  the  now  com- 
monly used  alkaloid  of  the  suprarenal  gland, 
which,  it  is  claimed,  allays  the  inflammation 
equally  well  and  has  the  marked  advantage  of  not 
inducing  the  habit. 

Solution  of  cocain  is  very  commonly  injected 
hypodermically,  to  produce  local  anesthesia  during 
such  slight  operations  as  the  evacuation  of  ab- 
scesses, the  removal  of  splinters,  bullets,  and  other 
foreign  bodies. 

When  there  is  considerable  inflammation  and  ex- 
treme tenderness,  stronger  solutions  are  required 
than  when  a healthy  surface  is  to  be  incised.  In 
the  former  case,  a syringe  having  a long,  fine 
needle,  is  filled  with  a 4 per  cent,  solution  of  cocain 
hydrochlorid,  the  needle  is  then  inserted  obliquely, 
or  almost  parallel  with  the  surface,  between  the 
layers  of  the  skin,  beyond  the  zone  of  increased 
tenderness,  and  a small  drop  of  solution  is  forced 
beneath  the  epidermis;  a white  spot  is  seen  in  a 
moment  and  the  needle  is  then  advanced  through 
that  toward  the  more  tender  area  without  removing 
the  point  of  the  needle  from  beneath  the  epidermis : 
with  each  advance  a drop  of  the  solution  is  in- 
jected. When  the  needle  has  been  passed  under 
the  epidermis  for  its  full  length,  it  is  withdrawn 
and  the  point  inserted  into  the  most  advanced 
blanched  area ; in  this  way,  using  a curved  needle, 


194 


PHARMACOPEIA  AND  PHYSICIAN. 


a complete  circuit  may  be  made  of  the  seat  of  in- 
flammation. The  object  of  injecting  the  solution 
between  the  layers  of  the  skin  is  to  secure  anesthe- 
sia with  a minimum  of  absorption  into  the  general 
circulation 

The  psychic  effect  on  the  patient  of  having  pain- 
less injections  made  into  such  an  extremely  tender 
region  tends  to  allay  the  nervous  dread  of  the 
knife,  which  is  a more  important  factor,  than  we, 
who  are  accustomed  to  seeing  pain,  are  apt  to 
realize. 

The  injection  of  a solution  of  cocain  into  the 
hand  is  apt  to  prove  ineffective  when  the  trouble 
is  deep  seated,  as  in  palmar  abscess,  and  in  such 
cases  it  is  better  to  inject  a small  amount  of  a 2 
or  3 per  cent,  solution  around  or  into  the  nerve 
trunks  in  the  forearm. 

The  injection  of  strong  solutions  into  nerve 
trunks  has  given  rise  to  much  trouble  and  it  is 
preferable,  therefore,  to  try  to  secure  the  effects 
from  weak  solutions. 

Anesthesia  involving  all  the  body  below  the  site 
of  the  injection,  may  be  secured  by  injecting  about 
ten  or  fifteen  minims  of  a 2 per  cent,  solution  of 
cocain  hydrochlorid  into  the  subarachnoid  cavity 
through  a sterilized  platinum  needle  which  is  in- 
serted at  the  side  of  the  fourth  lumbar  vertebra. 
The  patient  must  be  placed  in  a sitting  position, 
in  order  that  gravity  may  not  favor  the  passage  of 
the  solution  up  to  the  medulla. 

This  method  of  using  cocain  (or  any  othetr  drug) . 
is  attended  with  so  much  danger  that  it  is  not 
justifiable  except  when  for  some  reason,  general 
anesthesia  is  not  practicable. 

The  anesthesia  is  induced  in  ten  or  fifteen  min- 


LOCAL  ANESTHETICS. 


195 


utes,  with  cocain,  but  its  duration  is  very  variable, 
lasting  from  half  an  hour  to  five  hours. 

When  the  application  of  a constricting  band  is 
not  feasible  the  previous  injection  of  a solution  of 
the  suprarenal  gland,  as  previously  suggested,  will 
delay  the  absorption  of  the  solution  of  cocain  into 
the  general  circulation.  It  should  be  remembered, 
however,  that  the  use  of  a vasoconstrictor  only  de- 
lays and  does  not  prevent  the  absorption  of  the  co- 
eain.  When  a 'large  amount  of  the  cocain  so- 
lution is  necessary  it  will  probably  be  prefer- 
able to  use  the  infiltration  method  as  proposed 
by  Schleich.  It  is  difficult  to  see  what  advantage 
is  to  be  gained  by  the  addition  of  morphin  to  a 
solution  instead  of  directing  the  injection  of 
the  desired  amount  at  once  so  as  to  secure  its 
systemic  effect.  Schleich  recommended  solutions 
containing  from  0.01  gm.  (1/6  grain)  to  0.2  gm. 
(3  grains)  of  cocain  hydrochlorid  and  from  0.005 
gm.  (1/12  grain)  to  0.25  gm.  grain)  of  mor- 
phin hydrochlorid  in  100  c.c.  (3  fluid  ounces)  of 
0.2  of  1 per  cent,  solution  of  sodium  chlorid  to 
which  was  added  one-fourth  of  a drop  of  phenol. 

Strong  solutions  of  cocain  should  not  be  used  in 
carious  teeth,  and  only  small  amounts  of  the  weak 
solution.  One  or  two  drops  of  a 1 per  cent,  solu- 
tion often  affords  relief  from  toothache. 

Cocain  is  sometimes  applied  to  hemorrhoids  to 
lessen  the  pain  and  it  may  be  said  that  its  local  use 
is  much  more  rational  than  is  that  of  opium,  since 
the  alkaloid  morphin  has  no  local  analgesic  or 
vasoconstrictor  action,  a fact  to  be  remembered 
when  prescribing  urethral  injections,  and  lotions 
for  inflamed  surfaces  of  the  skin. 

Cocain  has  also  been  used,  in  small  doses,  to  re- 


196 


PHARMACOPEIA  AND  PHYSICIAN. 


lieve  nausea.  It  may  be  given  alone  or  with  other 
antiemetics.  The  following  is  an  example  of  a 
combination  with  cerium  oxalate,  the  latter  being 
used  empircally. 


R.  Cocain*  hydrochloratis  gr.  i 0106 

Cerii  oxalas  gr.  xvi  1 

Aquae  aurant.  flor  f.  gi  30 1 


M.  Sig. : Shake  the  mixture  and  give  one  teaspoonful 
every  half  hour  when  needed. 

Many  substitutes  for  cocain,  of  greater  or  less 
merit,  have  been  brought  forward  by  manufac- 
turers, and  while  they  have  been  widely  heralded 
as  being  superior  to  cocain,  they  are  not  free  from 
disadvantages;  though  the  manufacturers  have 
not,  as  yet,  devoted  much  time  or  space  to  the 
exploitation  of  these  several  disadvantages  or 
dangers.  Their  further  consideration,  however, 
does  not  belong  in  a treatise  on  the  Pharmacopeia. 

THE  ATROPIN  GROUP. 

Atropin,  which  will  be  mentioned  among  the 
analgesics,  act  locally  as  an  anesthetic,  its  effects 
resembling  those  of  cocain,  but  being  weaker. 

Atropina. — U.  S. — Atropin  is  officially  de- 
scribed as  an  alkaloid  obtained  from  Atropa  Bel- 
ledonnn  and  from  other  plants  of  the  same  fam- 
ily. As  it  occurs  in  commerce,  it  is  usually  con- 
taminated by  a small  amount  of  hyoscyamin  from 
which  it  can  not  be  readily  separated. 

Atropin  is  soluble  in  450  parts  of  water  and  in 
1.5  parts  of  alcohol.  It  is  very  poisonous,  the 
average  dose  being  0.0004  gm.  (1/160  grain),  and 
it  should,  therefore,  be  tasted  with  the  utmost  cau- 
tion and  only  in  dilute  solution. 

■ Atrophy  Sulphas. — U.  S. — This  is  the  sul- 


LOCAL  ANESTHETICS. 


197 


phate  of  the  alkaloid  atropin.  In  its  physiologic 
properties  and  dose,  atropin  sulphate  corresponds 
closely  to  atropin.  It  is  soluble  in  less  than  one 
part  of  water  and  in  about  four  parts  of  alcohol. 

Oleatum  Atropina.— U.  S. — Oleate  of  Atro- 
pin is  a mixture  of  equal  parts  of  oleic  acid  and 
olive  oil  containing  2 per  cent,  of  atropin,  in  solu- 
tion. 

Extractum  Belladonna  Foliorum. — U.  S. — 
Extract  of  Belladonna  Leaves  is  directed  to  be 
made  with  a menstruum  consisting  of  two  parts  of 
alcohol  and  one  part  of  water,  and  should  contain, 
when  assayed  according  to  the  process  given  in 
the  Pharmacopeia,  1.4  per  cent,  of  mydriatic  al- 
kaloids. 

Unguentum  Belladonna. — U.  S. — Belladon- 
na Ointment  contains  10  per  cent,  of  extract  of 
belladonna  leaves  in  a mixture  of  hydrous  wool  fat 
and  benzoinated  lard. 

Ehplastrum  Belladonna. — U.  S. — Belladon- 
na Plaster  is  now  directed  to  be  made  by  mixing 
30  parts  of  extract  of  belladonan  leaves  with  70 
parts  of  adhesive  plaster,  and  corresponds  closely 
with  the  widely  used,  commercial,  rubber-base 
plasters.  It  is  further  directed  that  spread  bella- 
donna plasters  should  yield,  when  assayed  by  the 
process  given  in  the  Pharmacopeia,  not  less  than 
0.38  nor  more  than  0.42  per  cent,  of  mydriatic 
alkaloids. 

Eluidextractum  Belladonna  Badicis. — 
E.  S. — Fluidextract  of  Belladonna  Boot  is  directed 
to  be  made  with  a mixture  containing  four  parts 
of  alcohol  and  one  part  of  water,  and  should  yield, 
when  assayed  by  the  process  given  in  the  Phar- 


198 


PHARMACOPEIA  AND  PHYSICIAN. 


macopeia,  0.5  per  cent,  of  mydriatic  alkaloids  from 
belladonna  root. 

Linimentum  Belladonna. — U.  S. — Belladon- 
na Liniment  is  virtually  a solution  of  five  parts  of 
camphor  in  a sufficient  quantity  of  fluidextract  of 
belladonna  to  make  100  parts. 

Fluidextractum  Stramonii. — U.  S. — This  is 
directed  to  be  made  from  the  leaves  of  Datura 
Stramonium  with  a menstruum  containing  two 
parts  of  alcohol  and  one  part  of  water.  The  fin- 
ished fluidextract  is  required  to  contain  0.35  per 
cent,  of  the  mydriatic  alkaloids  from  stramonium. 

Extractum  Stramonii. — TJ.  S. — Extract  of 
Stramonium  is  made  by  evaporating  the  fluidex- 
tract to  the  required  consistency,  and  should  con- 
tain 14  per  cent,  of  mydriatic  alkaloids. 

Unguentum  Stramonii.— IT.  S. — Stramonium 
Ointment  contains  10  per  cent,  of  extract  of  stram- 
onium in  a mixture  of  hydrous  wool  fat  and  ben- 
zoinated  lard. 

Atropin  and  the  extracts  of  belladonna  and  of 
stramonium,  in  the  form  of  ointments,  belladonna 
plaster  and  belladonna  liniment  are  very  common- 
ly employed  as  local  applications  for  the  relief  of 
the  various  neuralgias.  The  members  of  the  atro- 
pin group  are  said  to  be  more  efficacious  in  facial 
than  in  other  neuralgias,  but  they  are  also  used 
for  the  intercostal  variety  and  for  lumbago. 

Belladonna  plasters  are  very  commonly  used, 
particularly  by  the  laity,  for  a variety  of  pains, 
often  serving  merely  to  protect  the  surface,  or  for 
the  retention  of  body  heat. 

Suppositories  of  extract  of  belladona  are  fre- 
quently used  with  benefit  in  the  treatment  of 
hemorrhoids. 


LOCAL  ANESTHETICS. 


199 


They  may  be  directed  somewhat  as  follows : 

R.  Extra eti  belladonnse  fol grs.  i 1 06 

Olei  theobromatis  3ii  8| 

M.  Ft.  suppositoria  No.  viii. 

Sig. : One  every  four  hours,  as  directed. 

Belladonna  ointment  may  be  used  for  the  same 
purpose.  It  may  be  directed  to  be  spread  on  a 
little  cotton  which  is  placed  in  contact  with  the 
piles  and  they  are  then  replaced  in  the  rectum.  If 
they  still  tend  to  protrude  a pad  of  cotton  is  placed 
over  the  anus  and  held  in  position  by  a bandage. 
For  men  the  bandage  may  be  attached  to  the  sus- 
penders, both  back  and  front,  when  the  severity 
of  the  attack  is  not  such  as  to  compel  the  patients 
to  lie  down. 

It  must  be  remembered  that  the  extract  of  bel- 
ladonna, whether  applied  as  a suppository  or  oint- 
ment, is  rapidly  absorbed  and  the  amount  so  used 
must  not  exceed  the  therapeutic  dose. 

ACONITE. 

Aconite  owes  its  action  almost  entirely  to  aconi- 
tin,  an  alkaloid  which,  like  cocain,  is  composed  of 
a base  united  to  an  aromatic  acid.  Closely  re- 
sembling aconitin  in  its  local  action  is  veratrin. 
They  both  cause  irritation  wrhen  applied  to  the 
mucous  membrane. 

The  effect  of  aconitin  when  taken  by  the  mouth 
is  very  characteristic,  the  local  effect  being  a tin- 
gling and  then  a disagreeable  sensation  in  the 
throat  which  has  been  variously  termed  itching  or 
“scratching.”  Applied  to  the  skin  aconitin  causes 
sensory  stimulation,  which  is  succeeded  bv  local 
anesthesia  without  the  production  of  rubefaction. 


200 


PHARMACOPEIA  AND  PHYSICIAN. 


Aconitin  is  much  less  efficacious  than  cocain  as 
a local  anesthetic,  and,  of  course,  its  injection  is 
wholly  inadmissible,  but  it  is  much  more  useful  in 
the  form  of  a liniment  which  is  to  be  applied  to  the 
unbroken  skin,  through  which  aconitin  may  pene- 
trate to  a slight  extent. 

Aconitine — U.  S. — An  alkaloid  obtained  from 
the  official  aconite,  the  tuberous  root  of  Aconitum 
napellus.  There  are  a number  of  closely  related 
species  of  aconite  that  contain  alkaloids  which 
differ  widely  in  their  physiologic  action  and  dose. 
The  now  official  aconitin  is  the  purified  crystalline 
alkaloid  of  the  official  root  and  should  not  be  con- 
founded with  the  amorphous  alkaloid  formerly 
official  or  with  any  one  of  the  more  potent  alka- 
loids obtained  from  other  species  of  aconite. 

Aconitin  is  soluble  in  3,200  parts  of  water  and 
in  22  parts  of  alcohol.  On  account  of  the  poison- 
ous character  of  this  alkaloid  it  should  never  be 
tasted,  except  when  in  very  dilute  solution. 

Average  dose:  0.00015  (0.15  mg.  or  1/400 
grain). 

Fluidextractum  Aconite — IT.  S. — Fluidex- 
tract  of  Aconite  is  directed  to  be  made  from  the 
powdered  root  of  Aconitum  napellus  with  a men- 
struum composed  of  three  parts  of  alcohol  and  one 
part  of  water.  It  should  contain  no  less  than  0.4 
per  cent,  of  aconitin. 

Tinctura  Aconite — U.  S. — This  tincture  now 
represents  10  parts  of  the  crude  drug,  instead  of 
35  parts,  as  formerly  official.  It  is  made  with  a 
menstruum  containing  7 parts  of  alcohol  and  3 
parts  of  water,  and  the  finished  tincture  should 
contain  0.045  per  cent,  of  aconitin. 


LOCAL  ANESTHETICS. 


201 


YERATRIX. 

Somewhat  closely  related  to  aconitin,  in  its  vari 
ous  properties  and  uses,  is  veratrin,  which  is  offi- 
cial in  several  well  known  forms. 

Yeratresta. — TJ.  S. — The  official  Veratrin  is  a 
mixture  of  alkaloids  obtained  from  the  seeds  of 
Asagrcea  officinalis.  It  occurs  as  a white  or  a 
grayish-white  amorphous  powder  that  is  soluble  in 
about  1,750  parts  of  water  and  in  2.2  parts  of 
alcohol. 

Oeatuat  Yeratrixjl — TJ.  S.  Oleate  of  Yera- 
trin  contains  2 per  cent,  of  veratrin  in  a mixture 
of  equal  parts  of  oleic  acid  and  olive  oil. 

IJxguextum  Yeratrixee. — pi.  S. — Yeratrin 

Ointment  contains  4 parts  of  veratrin  with  6 parts 
of  expressed  oil  of  almonds  and  90  parts  of  ben- 
zoinated  lard. 


LOCAL  USES  OF  ACOXITIN. 

Aconitin  is  sometimes  used  locally  in  the  form 
of  an  ointment  (from  1 to  100  to  1 to  500),  or  in 
the  form  of  an  oleate,  made  similarly  to  the  offi- 
cial oleates  of  atropin  or  of  veratrin,  of  2 per  cent, 
strength,  for  the  relief  of  rheumatism  and  neu- 
ralgia. Inasmuch  as  it  is  absorbed  in  these  forms 
from  the  unbroken  skin,  and  much  more  rapidly 
from  wounds  or  mucous  membranes,  it  must  be 
used  with  caution. 

For  facial  neuralgia  it  may  be  prescribed  as 
follows : 


R.  Aeonitini  gr.  iii 

Alcohol  q.  s.  to  dissolve 

Adipis  3iv 


M.  Ft.  unguentum.  Sig. : Apply  a very  little  of  the 
ointment  over  the  seat  of  the  pain. 


202 


PHARMACOPEIA  ARB  PHYSICIAN. 


The  fluidextract  of  aconite  may  be  further  con- 
centrated and  used  in  the  form  of  an  ointment,  or 
it  or  the  tincture  of  aconite  may  he  used  as  a lini- 
ment, applied  on  cloth,  and  a hot  pad  or  water  bot- 
tle laid  over  the  surface. 

For  muscular  rheumatism  a liniment  composed 
of  equal  parts  of  the  tincture,  or  a corresponding 
amount  of  the  fluidextract  and  soap  liniment  may 
be  rubbed  on  the  surface,  or,  if  desired,  this  lini- 
ment may  be  further  varied  by  the  addition  of 
chloroform  liniment,  or  other  alcohol  soluble 
rubefacient  in  place  of  the  soap  liniment. 

The  following  is  the  formula  recommended  by 
Magitot  for  toothache. 

IJ.  Tincturae  aconiti 

Chloroformi,  aa m.  xlv  3 

Tincturae  benzoini  m.  cl  10 

M.  Apply  as  needed. 

PHENOL. 

Phenol,  or  carbolic  acid,  has  been  considered 
under  the  subject  of  antiseptics. 

Applied  to  the  skin,  pure  or  in  concentrated  so- 
lution, it  causes  tingling  and  some  pain  with  the 
formation  of  a white  eschar  and  a rapidly  induced 
partial  or  complete  anesthesia  of  the  part.  It  is  so 
prone  to  absorption  when  weak  solutions  are  used 
that  its  usefulness  is  interfered  with  to  a great 
extent. 

Phenol. — U.  S. — The  Acidum  Carbolicum  of 
former  pharmacopeias  occurs  as  separate  needle- 
shaped  crystals  or  as  a white  crystalline  mass  that 
is  soluble  in  about  20  parts  of  water,  but  is  freely 
soluble  in  alcohol,  glycerin  or  in  fixed  or  volatile 
oils.  Phenol  will  absorb  or  dissolve  from  15  to 


LOCAL  ANESTHETICS. 


203 


20  per  cent,  of  water,  and  then  occurs  as  a color- 
less or  slightly  reddish  liquid. 

Phenol  Liquefactum. — U.  S. — Liquefied  Phe- 
nol should  contain  not  less  than  86.5  per  cent,  by 
weight,  of  absolute  phenol  and  about  13.6  per  cent, 
by  weight  of  water. 

Glyceritum  Phenolis. — U.  S. — Glycerite  of 
Phenol  consists  of  20  parts  of  liquefied  phenol  and 
80  parts  of  glycerin,  by  measure. 

TJnguentum  Phenolis. — TJ.  S. — Ointment  of 
Phenol  is  now  directed  to  contain  3 per  cent,  of 
phenol,  in  white  petrolatum. 

Phenol  is  rarely  if  ever  used  for  the  production 
of  anesthesia  preliminary  to  incising  the  skin,  but, 
in  the  form  of  the  glycerite  or,  preferably,  the 
ointment,  it  is  very  useful  in  allaying  the  pain  of 
small  ulcers  and  burns.  It  may  momentarily  in- 
crease the  pain,  but  this  is  soon  followed  by  less- 
ened sensibility. 

It  is,  of  course,  obvious  that  the  use  of  phenol 
is  not  permissible  where  large  surfaces  are  to  he 
treated. 

When  antisepsis  is  not  of  especial  importance 
the  ointment  is  to  be  preferred,  as  the  continuous 
application  of  even  comparatively  weak  aqueous 
solutions  to  the  extremities  has  caused  gangrene. 


CHAPTER  VIII. 


GENERAL  ANESTHETICS. 

The  subject  of  general  anesthesia  concerns  the 
surgeon  much  more  than  it  does  the  physician,  but, 
as  in  the  matter  of  antisepsis,  the  physician  must 
have  some  knowledge  of  this  subject,  and  we  shall, 
therefore,  briefly  consider  the  more  important 
members  of  the  group  of  general  anesthetics,  their 
uses  and  their  probable  limitations. 

Narcotics  have  been  used  from  time  imme- 
morial, for  producing  unconsciousness  during  sur- 
gical operations,  but  nitrous  oxid  has  been  in  use 
longer  than  any  other  agent  now  employed  for  in- 
ducing general  anesthesia.  It  is  more  than  100 
years  since  Sir  Humphrey  Davy  first  suggested  this 
use  for  nitrous  oxid,  but  his  suggestions  met  with 
no  response,  and  it  was  not  until  many  years  later, 
in  1844,  that  Horace  Wells,  a dentist  of  Hartford, 
Conn.,  employed  it  for  that  purpose  and  thus  in- 
troduced what  he  was  pleased  to  term  “ a new  era 
in  tooth-pulling.” 

It  was  at  one  time  supposed  that  nitrous  oxid 
caused  unconsciousness  merely  through  asphyxia, 
and  while  this  is  a very  important  factor,  it  has 
been  shown  that  nitrous  oxid  also  causes  a depres- 
sion of  the  central  nervous  system  resembling  that 
of  the  methane  derivatives  such  as  chloroform  and 
ether,  and  complete  anesthesia  has  been  produced 
without  asphyxia  by  using  a mixture  of  oxygen 
and  nitrous  oxid  under  pressure.  This  would 
probably  constitute  an  ideal  method  of  inducing 


GENERAL  ANESTHETICS. 


205 


anesthesia  were  it  not  for  the  mechanical  difficul- 
ties and  the  expense  that  it  necessarily  involves. 

Nitrous  oxid  is  usually  administered  only  for  a 
short  time,  it  being  necessary  to  discontinue  it  so 
soon  as  marked  cyanosis  of  the  face  occurs,  after 
which  the  anesthesia  lasts  for  about  a minute  or 
two.  It  is  the  safest  agent  which  we  possess  for 
general  anesthesia,  the  death  rate  being  approxi- 
mately one  in  half  a million  cases,  but  aside  from 
its  use  in  dentistry  and  for  inducing  unconscious- 
ness preliminary  to  other  anesthetics,  its  applica- 
tion is  extremely  limited. 

It  is  impossible  to  estimate  the  value  to  man- 
kind, and  to  surgery  in  particular,  of  the  introduc- 
tion of  anesthetization  with  ether  by  Morton  and 
Jackson  just  fifty  years  ago.  Its  use  by  Dr.  Craw- 
ford W.  Long,  in  Georgia,  antedates  by  more  than 
two  years  the  real  work  of  Morton  and  Jackson  in 
introducing  the  method,  but  the  greatest  credit  is 
due  those  men  for  their  splendid  achievement  in 
gaining  general  recognition  for  this  boon  to  hu- 
manity. 

Shortly  after  the  introduction  of  general  anes- 
thesia by  the  use  of  ether  Sir  J.  Y.  Simpson  an- 
nounced his  discovery  of  the  use  of  chloroform 
as  an  anesthetic,  and  this  latter  agent  soon  dis- 
placed ether  almost  entirely  in  many  parts  of  the 
world.  Even  at  present  chloroform  is  used  almost 
exclusively  in  several  European  countries. 

From  time  to  time  other  agents  have  been  pro- 
posed as  substitutes  for  chloroform  and  ether,  and 
some  of  them  have  enjoyed  a greater  or  less  popu- 
larity for  a time,  only  to  sink  into  obscurity. 

In  this  connection  we  may  mention  a few  of 


206  PHARMACOPEIA  AND  PHYSICIAN. 

those  which  will  he  remembered  even  by  the 
younger  generation  of  physicians,  and  which  have 
not  yet  fallen  into  complete  disuse. 

Ethyl  bromid  and  bromoform  have  been  used 
to  some  extent  as  general  anesthetics,  and  it  has 
been  suggested  that  the  typical  bromid  action 
might  be  obtained  from  them,  but  the  action  is 
that  of  the  entire  molecule.  Both  of  these  have 
passed  almost  completely  from  use  as  general  an- 
esthetics, largely,  perhaps,  because  of  the  unstable 
character  of  the  substances  themselves  and  the  ac- 
companying uncertainty  of  the  action  of  the  de- 
composition products. 

Petroleum  ether,  or  benzin,  because  of  its 
cheapness,  is  sometimes  used  in  vivisection  experi- 
ments, blit  not  on  man. 

The  use  of  mixtures  of  varying  composition  ap- 
pears to  offer  a peculiarly  interesting  field  for  ex- 
perimentation in  connection  with  general  anesthe- 
sia. 

Of  the  several  mixtures  that  have  been  used 
from  time  to  time,  that  popularly  known  as  the 
A.  C.  E.  mixture,  containing  1 part  of  alcohol,  2 
parts  of  chloroform  and  3 parts  of  ether,  is  per- 
haps the  one  that  has  been  used  most  widely.  This, 
also  referred  to  occasionally  as  the  one-two-three 
mixture,  was,  at  one  time  at  least,  quite  popular 
in  England.  While  it  has  been  urged  against  this 
mixture  that  the  differences  in  volatility  of  the 
three  substances  prevent  the  anesthetist  knowing 
just  what  he  is  administering,  it  is  a fact  that  the 
vapors  of  all  three  tend  to  pass  off  together,  and, 
furthermore,  the  object  is  to  induce  anesthesia  and 
to  avoid  an  excess  of  the  anesthetic  and  the  action 
of  the  mixture  seems  to  be  as  easily  controlled  as 


GENERAL  ANESTHETICS. 


207 


that  of  chloroform,  while  not  so  much  is  required 
as  of  ether  alone.  The  alcohol  and  chloroform 
raise  the  boiling  point  of  the  mixture  above  the 
temperature  of  the  lungs,  and  this  probably  secures 
some  of  the  advantages  claimed  by  Schleich  for 
the  mixture  of  ether,  chloroform  and  benzin. 

A mixture  containing  57  parts  of  ether  and  43 
parts  of  chloroform  has  been  suggested  as  having 
some  advantages  over  either  of  its  component 
parts.  It  was  at  one  time  quite  widely  recom- 
mended under  the  title  of  M.  S.  mixture,  but  ap- 
pears to  have  fallen  into  disuse,  having  probably 
no  advantage  over  the  better  known  A.  C.  E.  mix- 
ture mentioned  above. 

Dr.  Carl  Ludwig  Schleich  of  Berlin  some  years 
ago  recommended  the  admixture  of  5 per  cent,  of 
petroleum  ether,  or  benzin,  with  ether  and  chloro- 
form, as  a general  anesthetic.  This  preparation 
had  been  used  by  Schleich  in  nearly  500  cases  in 
which  he  obtained  excellent  results,  such  as  ab- 
sence of  excitement  and  of  the  excessive  salivary 
discharge  so  frequently  seen  with  ether,  while  the 
depressing  effect  of  chloroform  on  the  heart  was 
not  observed.  Despite  these  and  other  advantages, 
which  he  cited  at  the  time,  the  mixture  never  at- 
tained much  popularity,  and  even  Schleich  himself 
appears  to  have  discontinued  its  use  in  favor  of 
an  ethyl  chlorid  mixture. 

The  mixture  of  ether,  chloroform  and  ethyl 
chlorid  has  been  proposed  at  different  times  and  in 
varying  proportions ; the  one  proposed  by  Schleich 
contains  2 parts  of  ethyl  chlorid,  4 parts  of  chloro- 
form and  12  parts  of  ether,  and  is  fairly  repre- 
sentative of  this  class. 

The  advisability  of  using  mixtures  of  any  kind, 


208 


PHARMACOPEIA  AND  PHYSICIAN. 


for  general  anesthesia,  is  still  an  open  question, 
particularly  in  view  of  the  fact  that  the  several 
chemical  substances  themselves  are  far  from  being 
absolutely  stable,  even  under  the  most  favorable 
conditions,  chloroform  particularly  being  readily 
decomposed  and  forming,  as  one  of  the  possible 
decomposition  products,  the  really  dangerous  sub- 
stance known  as  phosgene. 

MAGNESIUM  SULPHATE. 

S.  J.  Meltzer  has  recently  suggested  the  use  of 
a solution  of  magnesium  sulphate  for  inducing 
general  anesthesia.  For  this  purpose  he  advised 
the  intraspinal  injection  of  1 c.c.  (15  minims)  of 
a 25  per  cent,  sterilized  solution  of  magnesium 
sulphate  for  each  25  pounds  of  body  weight.  This 
method  possesses  no  advantage  over  cocain  used  in 
the  same  way  for  producing  anesthesia  of  the  lower 
parts  of  the  body,  but  general  anesthesia  is  induced 
and  persists  for  some  hours,  and  the  method,  there- 
fore, may  possibly  prove  serviceable  in  controlling 
the  convulsions  of  tetanus. 

Marked  depression  of  the  respiration  occurs, 
and  Maury  and  Teague,  working  with  guinea-pigs 
and  injecting  the  solution  intraperitoneally,  have 
found  that  the  repetition  of  the  primary  anesthetic 
dose,  on  the  following  day,  sometimes  causes  death. 
It  must,  therefore,  be  used  only  with  extreme  cau- 
tion. The  sudden  introduction  of  a small  quan- 
tity of  this  solution  into  the  blood  vessels  will  im- 
mediately prove  fatal. 

SCOPOLAMIN-MOKPHIN  AND  SIMILAR  SOLUTIONS. 

The  constant  search  for  less  dangerous  anesthet- 
ics than  ether  and  chloroform  brings  many  sub- 
stances into  notice.  Morphin  and  scopolamin  have 


GENERAL  ANESTHETICS. 


209 


found  an  ardent  champion  in  Korff,  who  has 
used  them  for  several  years.  He  employs  up  to 
0.035  gm.  (y2  grain)  of  morphin  and  0.0013  gm. 
(1/45  grain)  of  scopolamin.  Unconsciousness 
does  not  occur,  and  he  claims  absolute  quiet  must 
be  maintained,  while  he  stops  operating  long 
enough  for  pain  to  subside.  He  advises  “drops”  of 
chloroform  or  ether  when  necessary.  The  tongue 
must  not  be  permitted  to  fall  back  into  the  throat. 
Its  application  in  surgery  must  obviously  be  very 
limited.  A discussion  of  a number  of  fatalities  at- 
tending the  use  of  morphin  and  scopolamin  for 
general  anesthesia  will  be  found  in  La  Semaine 
Medicale,  Hov.  8,  1905,  p.  529. 

Morphin  sulphate  alone  or  in  combination  with 
atropin  sulphate  is  very  commonly  employed  pre- 
liminary to  chloroform  or  ether  narcosis,  and  ap- 
pears to  have  well  established  uses  in  this  connec- 
tion. 

E.  Fraenkel  reported  some  ten  years  ago  that 
he  had  habitually  used  a mixture  of  morphin, 
atropin  and  chloral  for  hypodermic  injections,  pre- 
liminary to  narcosis,  for  twenty-two  years,  without 
an  accident.  He  claimed  that  this  procedure  les- 
sened to  an  extraordinary  degree  the  amount  of 
chloroform  or  ether  used  to  maintain  anesthesia. 

The  solution  used  by  Fraenkel  was  made  as  fol- 
lows : 


Morphin  muriate  

gr.  iiss 

|15 

Atropin  sulphate 

gr.  % 

015 

Hydrated  chloral 

gr-  iv 

25 

Distilled  water  

3ss 

15 1 

He  injected  hypodermically  from  1 c.c.  to  1.25 
c.c.  (15  to  19  minims)  fifteen  minutes  before  the 
commencement  of  the  ether  or  chloroform  admin- 
istration. 


210  PHARMACOPEIA  AND  PHYSICIAN. 

Fraenkel  further  asserts  that  this  mixture  is  free 
from  the  objectionable  side  actions  of  morphin, 
being  well  borne  by  patients  who  could  not  take 
morphin  by  the  mouth  or  hypodermically. 

ETHYL  CHLORID. 

A substance  which  bids  fair  to  rival  chloroform 
and  ether  as  a general  anesthetic,  under  certain 
conditions  at  least,  is  ethyl  chlorid. 

This  substance  is  extremely  volatile,  boiling  at 
from  12°  to  13°  C.  (54.5°  to  55.4°  F.),  and  it 
is  necessary,  therefore,  to  keep  it  in  sealed  tubes. 
The  ends  of  the  tubes  are  drawn  out  to  fine  capil- 
lary tubes  which  are  then  sealed,  or  the  capillary 
opening  is  closed  by  a metal  cap  which  may  be  re- 
placed when  a part  of  the  contents  of  the  tube  has 
been  used.  When  required  for  use  the  glass  tip 
is  broken  off,  or  the  metal  cap  unscrewed,  when  the 
heat  of  the  hand  causes  the  ethyl  chlorid  to  vola- 
tilize, forcing  out  a fine  stream  which  may  be  di- 
rected against  the  surface  which  is  to  be  frozen  for 
local  anesthesia,  or  the  stream  may  supply  the 
vapor  for  inhalation  to  produce  general  anesthesia. 

Ethyl  chlorid  induces  anesthesia  more  rapidly 
than  ether  does,  and  when  it  is  withdrawn  the  pa- 
tient recovers  more  quickly,  thus  saving  an  average 
of  some  twelve  minutes  on  each  operation,  hence  it 
is  likely  to  prove  useful  on  the  battlefield  and  in 
great  calamities  when  a number  of  operations  must 
be  performed  with  a minimum  loss  of  time. 

Figures  purporting  to  give  relative  degrees  of 
danger  for  various  anesthetics  are  notoriously  un- 
reliable, but  it  seems  probable  that  ethyl  chlorid  is 
less  dangerous  than  chloroform  and  somewhat 
more  dangerous  than  ether.  Among  the  objec- 


GENERAL  ANESTHETICS. 


211 


tionable  features  of  ethyl  chlorid  are  increased 
cost,  the  explosive  character  of  the  vapor,  extreme 
volatility,  the  accompanying  waste  of  material  and 
the  difficulty  of  administration. 

ACTION  OF  CHLOROFORM  AND  ETHER. 

It  would  hardly  be  profitable  to  discuss  here  in 
detail  the  actions  of  chloroform  and  ether,  but 
there  are  certain  important  points  concerning  them 
which  are  so  frequently  overlooked  that  we  will 
consider  them  briefly. 

While  there  are  records  of  as  many  as  40,000 
consecutive  anesthetizations  with  chloroform  with- 
out a fatality,  this  is  only  possible  in  case  of  skilled 
anesthetists  working  with  carefully  selected  cases. 
Certainly  no  such  results  are  possible  in  ordinary 
practice,  and  with  that  alone  we  are  concerned 
at  present. 

We  must  always  remember  that  the  production 
of  general  anesthesia  is  a grave  matter,  in  which 
death  is  an  ever  present  possibility  despite  the  ut- 
most care,  and  of  which  there  is  actual  danger  un- 
less caution  is  observed.  The  possibility  of  fatal 
complications  in  all  cases  of  general  anesthesia 
would  appear  to  make  it  necessary  that  the  patient 
or  his  friends  be  informed  of  this  fact,  if  for  no 
other  reason  than  to  protect  the  physician  admin- 
istering the  anesthetic. 

Each  case  must  be  carefully  considered  when  se- 
lecting the  anesthetic,  and  neither  chloroform  nor 
ether  should  be  used  exclusively.  Ether  being  the 
safer,  however,  should  have  the  preference,  when 
it  is  not  contraindicted,  and  chloroform  should 
not  be  used  unless  the  anesthetist  is  experienced 
and  is  reasonably  skilled  in  the  use  of  it. 

The  following  are  some  of  the  principal  advan- 


212 


PHARMACOPEIA  AND  PHYSICIAN. 


tages  and  contraindictions  of  both  of  these  agents : 

The  vapor  of  ether  is  inflammable,  that  of  chlor- 
oform is  not,  and  the  latter  is  to  be  preferred  when 
operations  are  to  be  performed  by  gas  or  lamp- 
light. In  this  connection,  however,  we  must  not 
forget  that  chloroform  vapor  coming  in  contact 
with  an  open  flame  is  readily  decomposed  into 
chlorin  and  hydrochloric  acid,  and  that  it  will  be 
necessary,  therefore,  to  provide  for  free  ventila- 
tion to  eliminate  these  decomposition  products.  If 
ether  must  be  used  under  such  circumstances,  the 
light-  should  be  placed  as  high  above  the  level  of  the 
mask  as  practicable,  since  ether  vapor  is  heavier 
than  air.  The  thermocautery  can,  of  course,  also 
ignite  the  vapor  of  ether. 

An  acute  cold  is  a contraindiction  to  the  use  of 
any  anesthetic,  but  more  particularly  to  the  use  of 
ether.  Ether  is  also  contraindieted  in  bronchitis, 
because  of  the  great  irritation  caused  by  the  rela- 
tively large  amount  necessary  to  maintain  anes- 
thesia; it  is  likewise  contraindicated  in  nephritis, 
since  the  kidneys  take  part  in  the  excretion,  and 
suffer  from  the  irritant  action. 

In  extremely  hot  weather,  that  is,  when  the  ther- 
mometer is  above  93°  to  95°  F.  (34°  to  35°  C.), 
ether  is  volatilized  so  rapidly  that  the  atmosphere 
contains  amounts  which  may  prove  objectionable, 
and  it  often  becomes  very  difficult  to  maintain  com- 
plete anesthesia. 

When  it  is  absolutely  imperative  to  reduce  the 
stage  of  excitement  to  the  minimum,  or  when  it 
becomes  necessary  to  secure  complete  anesthesia 
rapidly,  ether  is  contraindicated  and  chloroform  is 
to  be  preferred  when  it  is  not  specifically  contra- 
indicted  for  other  and  more  important  reasons.  In 


GENERAL  ANESTHETICS. 


213 


the  latter  event  ethyl  chlorid  may  be  used,  or  pre- 
liminary unconsciousness  may  be  induced  by  ni- 
trous oxid,  and  this  followed  up  by  the  use  of  ether. 

Chloroform  is  very  commonly  preferred  by  ob- 
stetricians, but  deep  anesthesia  is  not  usually  in- 
duced in  such  cases. 

In  fatty  disease  of  the  heart  chloroform  is  con- 
traindicated because  it  also  induces  fatty  degenera- 
tion of  that  organ,  and  for  this  reason  it  is  not  ad- 
visable to  use  it  repeatedly  on  the  same  person  in 
succeeding  operations. 

Chloroform  is  much  more  toxic  to  the  heart  than 
ether,  and  there  is  a much  narrower  margin  for 
safety  between  the  amount  necessary  to  induce  an- 
esthesia and  that  which  causes  death,  chloroform 
being  thirty-six  times  as  active  as  ether  in  induc- 
ing anesthesia,  but  forty-eight  times  as  toxic. 

A matter  of  the  greatest  importance,  especially 
for  the  unskilled  anesthetist,  is  the  very  brief  in- 
terval between  the  cessation  of  respiration  and  the- 
stopping  of  the  heart  beat  with  chloroform,  giving; 
very  little  chance  to  resuscitate  the  patient  after 
respiration  has  stopped.  With  ether  the  interval 
is  much  longer,  and  the  prompt  resort  to  artificial 
respiration,  while  the  body  is  raised  higher  than 
the  head,  very  commonly  results  in  saving  the  pa- 
tient. 

This  difference  in  the  action  of  anesthetics  and 
also  the  fact  that  the  condition  of  anesthesia  is  a 
dangerous  one,  according  to  the  degree  to  which  it 
is  carried,  will  be  more  fully  appreciated  if  we 
have  a clear  conception  of  the  several  stages  of  an- 
esthesia and  the  rapidity  with  which  a patient  may 
pass  from  one  stage  into  the  other. 

These  several  stages  are  usually  designated  as: 


214 


PHARMACOPEIA  AND  PHYSICIAN. 


1,  the  stage  of  excitement;  2,  the  narcotic  and 
anodyne  stage ; 3,  complete  anesthesia ; 4,  paraly- 
sis and  death. 

The  acceleration  of  the  circulation  noticed  in  the 
first  stage  is  similar  to  that  produced  by  the  inges- 
tion of  alcohol  or  alcoholic  beverages,  and  the  pro- 
duction of  this  stage  was  one  of  the  uses  to  which 
ether  was  put  long  before  it  was  used  as  an  anes- 
thetic in  surgical  operations.  From  this  stage  the 
patient  usually  passes  quite  gradually  into  the 
second  or  narcotic  stage. 

In  the  narcotic  stage  sensibility  becomes  im 
paired,  but  there  is  not  infrequently  a persistence 
of  reflex  action  which  manifests  itself  in  a form  of 
delirium  or  wild  excitement.  This  is  usually  an 
indication  of  faulty  anesthetization  and  is  a com- 
plication that  can  be  avoided  in  many  instances  by 
the  more  careful  preparation  of  the  patient  for  the 
anesthetic.  In  the  majority  of  instances,  however, 
the  patient  passes  rapidly  into  the  third  stage,  that 
of  complete  anesthesia. 

This  difference  in  the  action  of  anesthetics  and 
there  is  complete  absence  of  reflex  action,  even  of 
the  conjunctiva,  which  is  usually,  though  erron- 
eously, advocated  as  the  most  satisfactory  test  for 
complete  anesthesia.  A satisfactory  surgical  anes- 
thesia is  indicated  by  complete  relaxation  of  nearly 
all  of  the  muscles  , of  the  body,  regular  breathing, 
deep  inspirations  and  a fully  relaxed  lower  jaw. 
The  widely  prevailing  though  barbarous  habit  of 
touching  the  conjunctiva  should  never  be  re- 
sorted to. 

By  the  careful  administration  of  the  anesthetic 
this  stage  of  surgical  anesthesia  may  be  continued 
for  a considerable  period  of  time,  but  we  must 


GENERAL  ANESTHETICS. 


215 


never  forget  that  it  is  ever  bordering  on,  and  may 
at  any  moment  pass  into,  the  fourth  or  paralytic 
stage,  when  respiration  ceases,  the  heart  heats  be- 
come feebler,  and,  unless  vigorous  and  prompt 
restorative  measures  can  be  resorted  to,  may  cease 
entirely. 

THE  ADMINISTRATION  OF  ETHER. 

While  it  has  been  asserted  that  the  administra- 
tion of  anesthetics  is  an  art  that  can  not  be  taught 
or  learned,  but  must  be  acquired,  it  is  also  true 
that  there  are  certain  points  or  rules  that  have  been 
sufficiently  well  established  to  warrant  their  being 
heeded,  and  the  general  conduct  of  anesthetization 
can  best  be  illustrated,  perhaps,  by  giving  the 
method  pursued  by  an  ordinarily  careful  anes- 
thetist. 

The  patient  is  made  thoroughly  comfortable,  in 
a recumbent  position,  on  a table  or  wheel  stretcher, 
if  in  a hospital,  with  a pillow  just  sufficient  to  raise 
his  head  but  slightly. 

The  mouth  is  freed  from  false  teeth  and  other 
foreign  materials,  and  the  lips  and  nose  are  an- 
ointed with  petrolatum  to  avoid  the  accompanying 
irritation  from  contact  with  the  anesthetic. 

A pad  of  moistened  gauze  is  then  placed  over  the 
eyes  to  avoid  irritation  by  the  fumes  of  the  anes- 
thetic. 

All  these  several  stages  should  be  carefully  ex- 
plained to  the  patient  so  as  to  assure  him  that 
every  possible  precaution  is  being  taken  to  provide 
for  his  comfort  and  well-being,  and  to  gain  his 
confidence,  for  the  more  important  feature  of  ad- 
ministering the  anesthetic  itself. 

After  the  patient  has  been  prepared  and  his  con- 
fidence gained  by  explanation  of  the  several  stages 


216 


PHARMACOPEIA  AND  PHYSICIAN. 


of  the  preparation,  he  is  allowed  to  accustom  him- 
self somewhat  gradually  to  the  taste  and  smell  of 
ether.  To  accomplish  this  the  cone  or  gauze  con- 
taining the  anesthetic  is  held  some  slight  distance 
from  his  face,  and  gradually  brought  closer  as  the 
patient  becomes  more  and  more  accustomed  to  the 
inhalation.  If  the  anesthetist  has  been  successful 
in  gaining  the  confidence  of  the  patient  he  will 
find  that  the  latter  will  pass  through  the  prelim- 
inary stages  of  anesthesia  without  a struggle,  and 
that  complete  relaxation  will  be  secured  with  a 
minimum  of  the  anesthetic. 

When  a patient  has  been  completely  anesthetized 
very  little  of  the  anesthetic  will  suffice  to  maintain 
the  condition  and  the.  further  efforts  of  the  anes- 
thetist can  be  devoted  to  observing  the  respiration 
and  the  surface  reflexes  of  the  patient  in  order  to 
prevent  his  reverting  to  the  second  stage  of  anes- 
thesia, or  passing  on  into  the  much-to-be-dreaded 
stage  of  paralysis  of  the  respiratory  center. 

With  chloroform  the  passing  from  one  stage  of 
anesthesia  to  the  next  is  much  more  rapid  than 
with  ether,  less  of  the  anesthetic  is  used,  more  air 
must  be  allowed,  and  there  is,  of  course,  a cor- 
respondingly smaller  margin  of  safety  in  the  stage 
of  complete  surgical  anesthesia. 

Since  all  of  us  can  not  become  expert  anesthet- 
ists and  yet  must  at  times  perform  that  office,  this 
advantage  of  ether  is  well  worth  consideration. 

The  greatest  immediate  danger  from  inhalation 
of  ether  or  chloroform,  but  more  especially  of  the 
latter,  is  the  administration  of  the  vapor  in  too 
great  concentration.  One  hundred  volumes  of  air 
require  approximately  from  three  to  four  volumes 
of  ether  vapor,  and  100  volumes  of  air  require 


GENERAL  ANESTHETICS. 


217 


about  one  volume  of  the  vapor  of  chloroform  to  in- 
duce anesthesia,  but  an  increase  of  from  two  to 
three  volumes  in  the  concentration  of  the  ether, 
or  of  only  one  volume  of  chloroform  in  200  of  air 
will  prove  fatal  in  a short  time. 

While  we  do  not  actually  measure  the  relative 
volumes  of  air  and  vapor,  as  a rule,  these  figures 
will  serve  to  show  the  comparative  danger  of  the 
two  substances,  for  it'  is  many  times  more  difficult 
to  avoid  overstepping  narrow  boundaries  than 
broad  ones. 

When  a perfectly  safe  ratio  is  maintained  the 
delay  in  inducing  anesthesia  often  proves  vexa- 
tious, and  the  anesthetist  may  be  urged  to  expedite 
the  operation  by  increasing  the  concentration,  but 
he  should  never  -forget  the  grave  responsibility 
which  he  has  assumed  and  should  never  permit  the 
impatience  of  others  to  induce  him  to  exceed  the 
limits  of  caution,  save  only  in  those  grave  emer- 
gencies where  delay  in  operating  may  mean  death 
to  others  who  are  awaiting  their  turn. 

OFFICIAL  ANESTHETICS. 

JEthylis  Chloriduh. — U.  S. — Ethyl  chlorid 
occurs  as  a colorless,  transparent,  very  volatile 
liquid,  having  a characteristic,  rather  agreeable 
odor  and  a burning  taste.  It  is  only  slightly  sol- 
uble in  water,  but  is  readily  miscible  with  alcohol. 

Ethyl  chlorid  is  a haloid  derivative,  and  is  pre- 
pared by  the  action  of  hydrochloric  acid  gas  on  ab- 
solute ethyl  alcohol.  It  is  usually  marketed  in 
hermetically  sealed  glass  tubes,  and  when  liberated 
at  ordinary  room  temperature  volatilizes  almost  in- 
stantly. The  resulting  gas  is  very  inflammable 


218 


PHARMACOPEIA  AND  PHYSICIAN. 


and  the  substance  itself  should  never  be  used  in 
proximity  to  an  open  flame  or  fire. 

For  local  anesthesia  the  liquid  in  a fine  spray 
is  applied  to  the  surface  to  be  anesthetized. 

The  average  amount  necessary  to  induce  general 
anesthesia  is  from  5 to  10  c.c.  (75  to  150  minims). 

FEther. — U.  S. — Ether  is  a transparent,  color- 
less, volatile  liquid  having  a characteristic  odor 
and  a pungent,  sweetish  taste.  It  should  contain 
96  per  cent,  by  weight  of  absolute  ether  or  ethyl 
oxid  and  about  4 per  cent,  of  alcohol  containing  a 
little  water. 

The  per  cent,  content  of  ethyl  oxid  or  absolute 
ether  in  a given  specimen  is  a matter  of  consider- 
able importance  when  the  substance  is  to  be  used 
for  anesthesia.  The  official  ether,  when  exposed 
to  air,  absorbs  moisture,  thus  materially  re- 
ducing the  anesthetic  value  of  the  ether.  The 
practice  that  has  long  been  followed  of  sending 
out  ether  in  hermetically  sealed  cans  is  an  efficient 
safeguard  against  this  absorption  of  moisture. 

Chloroeormum. — U.  S. — Chloroform  is  a 

heavy,  clear,  colorless  liquid  having  a characteristic 
ethereal  odor  and  a burning,  sweet  taste.  It  should 
contain  not  less  than  99  per  cent,  by  weight  of  ab- 
solute chloroform  and  from  0.6  to  1 per  cent,  by 
weight  of  alcohol. 

Chloroform  when  not  pure  is  readily  decom- 
posed, forming  chlorin  compounds  that  may  prove 
to  be  extremely  dangerous  to  the  patient.  Even 
chloroform  that  corresponds  to  the  requirements 
of  the  Pharmacopeia  may  be  decomposed  in  the 
presence  of  damp  air  and  heat,  and  the  substance 
should,  therefore,  be  carefully  preserved  in  small, 
well-stoppered  bottles. 


CHAPTER  IX. 


EXPECTORANTS. 

The  prevalence  of  coughs  and  “colds”  in  the 
winter  months  is  sufficient  evidence  of  the  import- 
ance of  this  class  of  agents.  Their  use  in  domestic 
practice — largely  as  “patent  medicines,”  so-called 
— probably  exceeds  that  directed  by  the  physician 
as  ten  to  one. 

Physicians  are  supplied  liberally  with  literature 
by  manufacturers  of  proprietary  remedies  of  this 
type,  but  the  pharmacology  of  this  literature  is  not 
always  worthy  of  the  faith  that  some  physicians 
place  in  it.  As  an  example  we  quote  from  a circu- 
lar distributed  exclusively  to  physicians:  “In  se- 

vere and  frequent  cough,  when  little  mucus  is  se- 
creted, as  shown  by  the  scanty  viscal  sputum,  mor- 
phin,  or,  better,  its  derivative,  ethyl-morphin,  is 
indicated,  which  increases  secretion  and  lowers  ex- 
citability of  the  respiratory  center.”  For  compari- 
son with  this  interested  statement  by  the  manufac- 
turers we  quote  from  the  article  on  opium  in 
Wood’s  Therapeutics  (11th  ed.,  716)  : “Its  ten- 

dency to  cheek  secretion  forbids  its  use,  however, 
in  a very  large  proportion  of  cases,  notably  in  those 
in  which  there  is  persistent  dryness  of  the  bronchial 
mucous  membrane.”  Sollmann,  Cushny  and  oth- 
ers state  that  morphin  possesses  the  same  property, 
though  to  a lesser  degree  than  opium. 

In  their  proprietary  medicine  circular  manufac- 
turers usually  advocate  the  use  of  some  certain 


220 


PHARMACOPEIA  AND  PHYSICIAN. 


remedy  for  all  coughs,  but  we  may  be  pardoned  if 
we  again  quote  W ood  for  comparison : “It  is  plain 
that  the  medical  practitioner  must  study  in  each 
individual  case  the  relations  between  the  cough  .and 
the  amount  of  work  required/’ 

The  discovery  of  a medicinal  agent  is  the  signal 
for  a host  of  imitators  whose  product  may  differ, 
if  at  all,  merely  in  the  substitution  of  an  ethyl  for 
a methyl  group,  or  of  one  harmless  acid  radical  for 
another.  These  are  presented  in  increasing  num- 
bers to  the  physician,  who  can  by  no  possibility 
remember  them  all.  Or,  some  well-known  drug, 
whose  length  of  service,  if  not  merit,  entitles  it  to 
some  respect,  is  seized  on  to  serve  as  a basis  for 
fabulous  claims,  perhaps  long  since  voiced,  dis- 
proved and  forgotten. 

There  is  still  another  interesting  phase  con- 
nected with  these  various  nostrums.  Many  of  us 
pride  ourselves  on  the  fact  that  we  use  only  “eth- 
ical” preparations  and  also  that  we  insist  on  know- 
ing just  what  we  are  prescribing  or  using.  It  must 
be  rather  embarrassing,  therefore,  to  find  that 
even  the  public  is  more  exacting  in  this  respect 
than  we  are  and  that  the  manufacturers  of  popular 
medicines,  when  they  do  advertise  the  composition 
of  their  particular  mixture,  publish  a full  and 
complete  formula  and  not  an  incomplete  one  such 
as  we  frequently  find  in  the  advertising  pages  of 
medical  journals,  or  in  the  circulars  that  come  to 
our  desk. 

The  expectorants  official  in  the  United  States 
Pharmacopeia  afford  a great  variety  of  choice.  In- 
numerable combinations  are  possible,  but  we  shall 
merely  suggest  a few  of  these,  in  connection  with 
some  of  the  drugs  and  preparations  available. 


EXPECTORANTS. 


221 


It  should  be  remembered  that  coughing  serves  to 
remove  mucus  from  the  respiratory  tract  and 
usually  requires  no  treatment.  If,  however,  the 
cough  becomes  unduly  severe,  it  may  require  alle- 
viation; if  the  secretion  is  scanty  it  may  be  in- 
creased or  rendered  more  liquid. 

Acute  bronchitis  may  be  divided  into  two  gen- 
eral stages,  with  certain  expectorants  useful  in 
each  stage,  but  this  is  not  to  be  taken  as  a rigid 
classification. 

The  first  stage — that  of  dryness  of  the  mucous 
membrane,  with  considerable  cough — calls  for  sed- 
atives ; the  second — that  of  free  secretion — re- 
quires stimulant  expectorants. 

SEDATIVE  EXPECTORANTS. 

Among  the  official  sedative  expectorants  to  be 
used  in  the  first,  or  dry,  stage  of  cough,  we  have 
the  following: 

Ipecacuanha. — U.  S. — Ipecac  is  the  dried  root 
of  Cephaelis  Ipecacuanha  (Brotero),  A.  Bichard 
(Fam.  Rubiacece) . It  is  known  commercially  as 
Bio,  Brazilian  or  Para  ipecac,  or  the  corresponding 
portion  of  C.  acuminata , Ivarsten,  known  commer- 
cially as  Carthagena  ipecac,  yielding,  when  assayed 
by  the  process  given  in  the  Pharmacopeia,  not  less 
than  2 per  cent,  of  ipecac  alkaloids.  Ipecacuanha 
was  first  described  by  Piso  and  Markgraf,  in  1648, 
in  their  natural  history  of  Brazil.  The  drug  ap- 
pears to  have  been  well  known  to  the  natives  of 
Brazil  and  to  have  been  much  prized  for  a variety 
of  therapeutic  purposes.  It  was  introduced  into 
Europe,  about  1675,  by  John  Helvetius,  of  Paris. 
The  Carthagena  variety  of  ipecacuanha  is  a com- 


222 


PHARMACOPEIA  AND  PHYSICIAN. 


paratively  recent  introduction,  being  first  noted  as 
a distinct  variety,  about  1870.  Ipecacuanha  is  of- 
ficial in  all  pharmacopeias,  but  up  to  the  present 
time  the  Pharmacopeia  of  the  United  States  is  the 
only  one  to  recognize  the  Carthagena  variety  as 
being  the  equal  of  the  Brazilian. 

Pul  vis  Ipecacuanha. — U.  S. — Average  dose: 
Expectorant,  0.050  gm.  (1  grain) ; emetic,  1 gm. 
(15  grains). 

Fluidextractum  Ipecacuanha. — U.  S.; — 

Fuidextract  of  Ipecac.— This  should  contain  1.75 
per  cent,  of  alkaloids. 

Average  Dose:  Emetic,  1 c.c.  (15  minims); 

expectorant,  0.05  c.c.  (1  minim). 

Pulyis  Ipecacuanha  et  Opii. — U.  S. — Pow- 
der of  Ipecac  and  Opium  (Dover’s  powder).  This 
contains  10  per  cent,  of  ipecac,  10  per  cent,  of  pow- 
dered opium  and  80  per  cent,  of  sugar  of  milk. 

Average  Dose:  0.500  gm.  (7%  grains);  used 

chiefly  as  a diaphoretic. 

Syrupus  Ipecacuanha. — U.  S. — Svrup  of  Ipe- 
cac. This  contains  7 per  cent,  of  fluidextract  of 
ipecac  and  1 per  cent,  of  acetic  acid  in  a mixture 
of  glycerin,  sugar  and  water. 

Average  Dose:  Expectorant,  1 c.c.  (15  min- 

imus) ; emetic,  15  c.c.  (4  fluidrachms). 

Vinum  Ipecacuanha. — U.  S. — Wine  of  Ipe- 
cac. A mixture  of  10  per  cent,  of  fluidextract  of 
ipecac,  10  per  cent,  of  alcohol  and  80  per  cent,  of 
white  wine. 

Average  Dose:  1 c.c.  (15  minims). 

When  the  bronchi  are  inflamed  and  the  secretion 
is  scanty  or  thick  and  tenacious,  nauseants,  such 


EXPECTORANTS. 


223 


as  ipecac,  lead  to  increased  secretion  which  secures 
its  removal  by  coughing.  The  choice  of  nau- 
seants  is  guided  by  the  general  condition  of  the 
patient,  ipecac  being  preferred  to  antimony  and 
potassium  tartrate  in  those  eases  (children  and 
weakly  persons)  in  which  great  depression  would 
be  dangerous.  The  active  principle  of  ipecac  is 
not  usually  employed  in  the  pure  state  as  an  ex- 
pectorant, the  syrup  of  ipecac  being  preferred,  as 
the  tannin  present  retards  absorption  and  prolongs 
the  action. 

The  expectorant  dose  of  nauseants  is  always  very 
much  less  than  the  emetic— approximately  one- 
tenth  in  the  case  of  ipecac.  The  average  doses 
given  are  approximate  and  the  expectorant  dose  is 
to  be  repeated  every  two  or  three  hours ; the  emetic 
dose  is  to  be  repeated  half-hourly  until  effective. 

For  croup  in  small  children  few  remedies  enjoy 
a greater  reputation  than  syrup  of  ipecac,  which 
is  given  alone  in  doses  of  from  ten  to  thirty  drops, 
repeated  at  intervals  of  thirty  minutes  until  vom- 
iting occurs. 

The  preparations  of  ipecac  are  seldom  used 
alone  as  expectorants,  but  are  usually  added  to 
mixtures  of  allied  use. 

The  following  may  be  considered  a typical  pre- 
scription for  ipecac  to  be  used  in  teaspoonful  doses 
every  two  hours;  for  the  syrup  of  ipecac  a corre- 
sponding amount  of  fluidextract  or  wine  may  be 
substituted.  When  an  opiate  is  imperatively  de- 
manded 15  c.c.  (4  drachms)  of  camphorated  tinc- 
ture of  opium  may  be  added  without  other  change : 


R.  Syrupi  ipecacuanh®  3vi  25 1 

Ammonii  chloridi  3iss  6| 

Syrupi  tolutani,  q.  s.  ad §iii  100 1 


224 


PHARMACOPEIA  AND  PHYSICIAN. 


Senega. — U.  S. — Boot  of  Polygala  Senega — 
This  is  one  of  the  few  drugs  of  American  origin 
that  has  found  a place  in  every  recent  pharmaco- 
peia. It  contains  a saponin  which  is  locally  irri- 
tant, but  which  is  not  absorbed ; hence,  the  drug  is 
not  depressing.  It  is  almost  invariably  used  in 
small  amount  as  an  addition  to  other  expectorants. 
It  has  the  disadvantage  of  an  unpleasant  acrid 
taste.  The  official  preparations  are: 

Fluidextracttjm  Senegje. — U.  S. — Average 
dose,  1 c.c.  (15  minims),  and 

Syrupus  Senega. — U.  S. — This  contains  20 
c.c.  fiuidextract  of  senega  in  100  c.c. 

Average  Dose:  4 c.c.  (1  fluidrachm). 

See  also  compound  syrup  of  squill. 

Another  irritant  nauseant  more  notable  for  its 
abuse  than  use  is : 

Sanguinaria. — U.  S. — Rhizome  of  Sanguinaria 
canadensis  (bloodroot).  This  drug,  usually  omit- 
ted by  modern  therapeutists  or  dismissed  with  a 
line,  contains  sanguinarin,  belonging  to  the  mor- 
phin  group,  and  causing  depression  of  the  respira- 
tory center.  It  is  mentioned  here  more  particu- 
larly because  of  its  widespread  use  by  the  nostrum 
makers.  The  common  name — bloodroot — appears 
to  possess  considerable  psychical  effect.  The  In- 
dians, probably,  displayed  more  wisdom  in  its  use 
than  we  do ; they  only  applied  it  externally,  as  war 
paint.  The  only  official  preparation  is : 
Fluidextractum  Sanguinaria. — II.  S. 
Average  Dose:  0.1  c.c.  (1%  minims). 

The  “Compound  Syrup  of  White  Pine'-’  of  the 
National  Formulary  represents  the  “popular”  ex- 


EXPECTORANTS. 


225 


pectorant.  It  is  not  recommended,  however,  as  it  is 
too  complicated.1 

ANTIMONY. 

Antimony  and  potassium  tartrate  is  a more 
depressing  nauseant  than  the  drugs  above  men- 
tioned. It  may  be  used  on  robust  persons,  but  not 
with  safety  on  children  or  the  infirm.  Its  mode  of 
action  is  similar  to  that  of  ipecac,  and  here,  too,  we 
have  a variety  of  official  preparations. 

Antimonii  et  Potassii  Tartras. — U.  S. — 
Antimony  and  Potassium  Tartrate;  tartar-emetic. 
Colorless,  transparent  crystals  or  a white,  granu- 
lar powder,  soluble  in  15.5  parts  of  water.  This  is 
the  most  popular  and  widely  used  of  the  medicinal 
compounds  of  antimony,  and  is  now  official  in  all 
recent  pharmacopeias. 

Average  Dose:  Expectorant,  0.005  gm.  (1/10 

grain)  ; emetic,  0.03  gm.  (%  grain). 

Yinum  Antimonii. — TJ.  S. — Wine  of  Antimony. 
This  contains  0.4  per  cent,  of  antimony  and  potas- 
sium tartrate  in  solution  in  1 part  of  alcohol  and 
5 parts  of  white  wine,  and  enters  the  well-known 
compound  mixture  of  glycyrrhiza — a deservedly 
popular  expectorant. 

Average  Dose:  Of  the  wine  1 c.e.  (15  minims). 


1.  The  following  is  the  formula  for  the  Compound  Syrup 


of  White  Pine  : 

White  pine  hark  (pinus  strobusi  . . . . Jiiss  75 1 

Wild  cherry  bark  oiiss  75 

Spikenard  root 3iiss  10 

Balm  of  Gilead  buds  3iiss  10 

Sanguinaria  root  3ii  8 

Sassafras  bark  .’ grs.  cv  7 


Morphin  sulphate  grs.  viiss  5 


Chloroform  3iss  6 

Sugar Sxsvss  750 

Alcohol 

Water 

Syrup  (TJ.  S.),  of  each  to  make Oil  1000 


226 


PHARMACOPEIA  AND  PHYSICIAN. 


Tartar  emetic  is  also  an  ingredient  (0.2  per 
cent.)  in  the  compound  syrup  of  squill. 

For  the  administration  of  antimony  and  potas- 
sium tartrate,  the  official  compound  mixture  of 
glycyrrhiza  (6  per  cent,  wine  of  antimony, 
0.024  per  cent,  antimony  and  potassium  tartrate) 
is  used  alone  or  with  4 gm.  (60  grains)  ammo- 
nium chlorid  to  60  c.c.  (2  ounces). 

A typical  prescription  containing  wine  of  anti- 
mony follows: 

R.  Vini  antimonii  3iv  15 1 

Aquae  chloroformi,  q.  s.  ad 3hi  100 1 

A teaspoonful  every  two  hours. 

Apomorphina:  Hydrochloridum. — U.  S. — 

Apomorphin  Hydrochlorid. — The  hydrochlorid  of 
an  alkaloid  prepared  from  morphin  by  the  abstrac- 
tion of  one  molecule  of  water.  It  is  soluble  in  40 
parts  of  water,  in  the  same  proportion  of  alcohol, 
practically  insoluble  in  all  other  solvents. 

Apomorphin  is  much  less  useful  as  an  expector- 
ant than  as  an  emetic,  its  action  being  brief. 

Average  Dose:  Expectorant,  0.002  gm.  (2  mg. 
or  1/30  grain)  ; emetic,  0.005  gm.  (5  mg.  or  1/12 
grain). 

Ammonii  Chloridum. — U.  S. — A white  cryst- 
alline powder,  without  odor,  having  a cooling  sa- 
line taste,  permanent  in  air,  soluble  in  2 parts  of 
water  and  in  50  parts  of  alcohol. 

As  sal  ammoniac,  this  substance  has  been  known 
from  a very  early  time.  It  is  popularly  supposed 
to  have  been  first  obtained  from  the  neighborhood 
of  the  Temple  of  Jupiter  Ammon,  in  Northern 
Africa. 

Ammonium  chlorid  was  known  to  the  Arabian 
physicians  and  was  described  by  Geber.  It  is  now 


EXPECTORANTS. 


227 


official  in  all  pharmacopeias.  Wood  recom- 
mends this  salt  in  the  stage  just  before  secretion 
becomes  free ; for  this  purpose  the  following  may 
be  used: 

Trochisci  Ammonii  Chloridi. — U.  S. — Bach 
troche  contains  0.1  gm.  (IV2  grains)  ammonium 
chlorid  and  0.2  gm.  (3  grains)  extract  of  glycyr- 
rhiza. 

Ammonium  chlorid  is  much  used  as  an  addition 
to  compound  mixture  of  glycyrrhiza  in  the  propor- 
tion of  4 gms.  (60  grains)  to  60  c.c.  (2  ounces), 
and  it  may  be  added  to  nearly  any  expectorant 
mixture  which  is  not  strongly  alcoholic. 

STIMULATING  EXPECTORANTS. 

Balsamum  Tolutanum. — U.  S. — Balsam  of 
Tolu  is  a balsam  obtained  from  Toluifera  bal- 
samum, a yellowish-brown  plastic  solid  that  has  a 
pleasant  aromatic  color  and  a mild  aromatic  taste. 
It  is  readily  soluble  in  alcohol,  nearly  insoluble  in 
water.  Balsam  of  tolu  was  first  described  by 
Monardes,  a Spanish  physician,  about  1574.  The 
drug,  it  is  said,  was  collected  in  a district  called 
Tolu,  near  Carthagena,  and  appears  to  have  been 
well  known  to,  and  used  by,  the  natives  of  Northern 
South  America.  Balsam  of  tolu,  at  the  present 
time,  is  a widely  used  and  popular  drug  and  is 
official  in  all  the  leading  pharmacopeias. 

Average  Dose:  1 gm.  (15  grains). 

Syrupus  Tolutanus. — U.  S. — Syrup  of  Tolu, 
containing  the  water-soluble  principles  of  5 per 
cent,  of  tincture  of  tolu  in  syrup. 

Average  Dose:  15  c.c.  (4  fluidrachms) . 

Tinctura  Tolutan^:.— U.  S. — Tincture  of 
Tolu,  a 20  per  cent,  solution  of  tolu  in  alcohol. 


228 


PHARMACOPEIA  AND  PHYSICIAN. 


Average  Dose:  2 c.c.  (30  minims). 

The  mildest  of  the  stimulant  expectorants  is 
syrup  of  tolu,  if,  indeed,  this  can  be  considered  as 
anything  more  than  a flavored  syrup.  The  balsam 
is  not  frequently  used  in  medicine,  but  may  be 
given  in  the  form  of  an  emulsion  made  with  acacia 
and  water  and.  sweetened  with  sugar. 

The  benzoic  acid  and  volatile  oil  in  the  balsam 
give  it  the  advantage  of  being  mildly  antiseptic,  the 
syrup,  however,  being  too  weak  to  be  effective  in 
the  dose  usually  employed. 

Balsamum  Peruvianum. — U.  S. — Balsam  of 
Peru  may  be  used  in  the  same  dose  and  for  the 
same  purpose  as  balsam  of  tolu. 

Attention  is  called  to  the  fact  that  the  urine  of 
persons  taking  such  amounts  of  these  balsams  gives 
a precipitate  with  nitric  acid  which  may  be  mis- 
taken for  albumin,  but  the  precipitated  resins  dis- 
solve in  alcohol,  while  albumin  does  not. 

Benzoinum. — U.  S. — This  balsamic  resin  is  also 
a harmless  stimulant,  useful  in  bronchial  irrita- 
tion. 

Tinctura  Benzoini. — U.  S. — A 20  per  cent, 
solution  of  benzoin  in  alcohol,  or : 

Tinctura  Benzoini  Composita. — IT.  S. — 
“Turlington’s  balsam,”  commonly  called  “Friar’s 
balsam”  (containing  benzoin,  aloes,  storax  and 
tolu),  may  also  be  given. 

Average  Dose  : 1 c.c.  (15  minims)  every  two 

hours. 

The  fact  that  these  expectorants  are  harmless  is 
a very  great  advantage — and  is  a point  to  be  par- 
ticularly remembered  in  the  treatment  of  small 
children,  in  whom  opiates  and  such  depressants  as 
antimony  and  potassium  tartrate  are  to  be  avoided. 


EXPECTORANTS. 


229 


Syrupus  Picis  Liquids. — U.  S. — Syrup  of 
Tar. — Containing  one-half  of  one  per  cent,  of  the 
soluble  principles  of  tar  in  syrup,  is  mildly  stimu- 
lant and  the  taste  is  not  unpleasant. 

Average  Dose:  4 c.c.  (1  fluidrachm). 

Tar  itself  has  a disagreeable  acid  taste  and  is 
not  often  used  in  substance. 

Tprpini  Hydras. — U.  S. — Terpin  Hydrate. 
— This  is  a body  closely  related  to  turpentine, 
camphor,  etc.  It  occurs  in  colorless,  lustrous, 
rhombic  prisms,  or  a white  crystalline  powder, 
nearly  odorless,  of  a slightly  aromatic  and  some- 
what bitter  taste,  soluble  in  about  200  parts  of 
water  and  in  10  parts  of  alcohol. 

Average  Dose:  0.1  gm.  (2  grains)  in  capsules 
or  elixir.  Owing  to  its  slight  solubility  in  water, 
the  elixir  must  be  strongly  alcoholic  and  glycerin 
be  substituted  for  syrup — a serious  objection  to  its 
general  use.  It  is  very  commonly  associated  with 
codein,  which  is  not  to  be  recommended  for  rou- 
tine practice. 

It  may  be  prescribed  as  the  unofficial  Elixir  of 
Terpin  Hydrate  and  Coclein  Sulphate.  Dose : Two 
teaspoonfuls,  containing  0.15  gm.  (2  grains)  ter- 
hydrate  and  0.024  gm.  (14  grain)  codein. 

Terpin  hydrate  has  been  known  for  some  time, 
but  was  not  used  in  medicine  until  after  Lepine 
published  the  results  of  his  physiologic  investiga- 
tion in  1885.  It  is  supposed  to  possess  the  anti- 
septic and  stimulating  effects  of  turpentine  with- 
out possessing  its  irritating  properties.  The  sub- 
stance soon  became  popular  and  was  included  in 
the  United  States  Pharmacopeia  for  1880.  It  is 
official  in  the  German  Pharmacopeia  and  in  the 
French  Codex. 


230 


PHARMACOPEIA  AND  PHYSICIAN. 


Terpin  hydrate  has  been  suggested  as  a remedy 
in  a variety  of  ailments,  but  it  appears  to  be  useful 
mainly  as  an  expectorant,  enjoying  a reputation 
particularly  among  the  nostrum  venders.  It  is  in 
reality,  useful  in  aiding  to  get  rid  of  secretion  from 
the  bronchial  mucous  membrane. 

Tekebenum. — U.  S. — Terebene. — This  is  a 
polymerization  product  derived  from  turpentine, 
which  it  closely  resembles. 

It  is  a colorless  liquid,  having  a rather  agreeable 
odor  and  an  aromatic,  somewhat  terebinthinate 
taste,  readily  soluble  in  3 times  its  volume  of  alco- 
hol, but  only  slightly  soluble  in  water. 

First  obtained  by  Soubeiran  and  Capitaine 
about  1841,  it  was  introduced  into  medicine  by  Dr. 
William  Murrell  about  1885;  it  was  made  official 
in  1890  and  in  the  British  Pharmacopeia  of  1898. 

It  is  used  in  much  the  same  conditions  as  terpin 
hydrate  ; its  immiscibilitv  with  the  mixtures  usu- 
ally employed  as  expectorants  has  interfered  in  no 
small  way  with  its  employment.  It  may  be  pre- 
scribed in  alcoholic  solution,  in  capsules  or  in  the 
form  of  an  emulsion. 

Average  Dose:  0.5  c.c.  (8  minims). 

Scilla. — U.  S. — Squill.  The  bulb  of  Urginea 
maritima,  containing  several  potent  principles,  it 
is  exceedingly  irritant  and  in  large  doses  toxic. 

Average  Dose:  0.1  gm.  (2  grains). 

Of  all  official  drugs  used  in  the  treatment  of 
cough,  few  are  better  known  than  squill,  the  syrup 
being  the  most  popular  of  its  preparations. 

This  drug  is  both  stimulant  and  nauseant ; 
hence,  it  is  used  in  both  stages  of  bronchitis. 

Syrupus  Scilla. — U.  S. — Syrup  of  Squill. 
This  represents  5 per  cent,  of  squill ; made  from 


EXPECTORANTS. 


231 


vinegar  of  squill,  and,  therefore,  containing  dilute 
acetic  acid;  it  is,  of  course,  incompatible  with  am- 
monium, and  other,  carbonates — a fact  not  infre- 
quently lost  sight  of  by  the  prescriber. 

Acetum  Scillje. — JJ.  S. — Vinegar  of  Squill. 
This  represents  10  per  cent,  of  the  drug  extracted 
with  dilute  acetic  acid. 

Average  Dose:  1 c.c.  (15  minims). 

Fluidextractum  SciLLiE. — U.  S. — Average 

Dose,  0.1  c.c.  (2  minims). 

Tinctura  SciLLiE. — U.  S. — This  represents  10 
per  cent,  of  the  drug. 

Average  Dose:  1 c.c  (15  minims). 

These  last  three  preparations  of  squill  are  sel- 
dom employed,  but  the  following  is  widely  used : 

Syrupus  Scill.e  Compositus. — U.  S. — Com- 
pound Syrup  of  Squill  (Hive  Syrup).  This  repre- 
sents 8 per  cent,  of  the  fluidextracts  of  squill  and 
senega  and  0.2  per  cent,  of  antimony  and  potas- 
sium tartrate  or  about  0.01  gm.  (%  grain)  to  the 
teaspoonful. 

Average  Dose:  2 c.c.  (30  minims). 

The  use  of  squill  as  an  emetic  is  not  free  from 
danger  and  the  drug  is  seldom  so  employed  alone. 

Creosotum. — U.  S.—  (or  Guaiacol. — TJ.  S., 
which  constitutes  up  to  90  per  cent,  of  creosote) 
is  used  as  a stimulant  expectorant.  There  is  con- 
siderable diversity  of  opinion  as  to  its  mode  of  ac- 
tion. It  seems  to  possess  little  germicidal  action 
so  far  as  the  lungs  are  concerned.  When  it  is  ad- 
ministered in  a bland  oil  very  large  doses  are  tol- 
erated, but  these  are  not  necessary  for  its  expector- 
ant effect. 

Numerous  compounds  of  creosote  and  of  guai- 
acol have  been  suggested  as  substitutes  for  the  ofB- 


232 


PHARMACOPEIA  AM)  PHYSICIAN. 


cial  products,  but  it  is  not  probable  that  they  pos- 
sess any  decided  advantages  over  the  official. 
Those  which  are  less  poisonous  are  probably  ab- 
sorbed from  the  alimentary  canal  to  a much  less 
degree  than  are  the  official  creosote  and  guaiacol. 

Among  the  guaiacol  compounds  is  the  proprie- 
tary “Ethacol,”  containing  ethyl-morphin,  a fact 
to  be  carefully  borne  in  mind,  as  the  name  of  the 
preparation  is  not  nearly  so  suggestive  of  morphin 
as  of  guaiacol.  The  manufacturers  of  this  article 
recommended  morphin  or  ethyl-morphin  in  bron- 
chitis for  increasing  secretion ! 

ANODYNES. 

When  the  irritability  of  the  throat  causes  excessive 
coughing,  anodynes  are  indicated.  Morphin,  how- 
ever, must  only  be  used  with  the  greatest  caution 
owing  to  its  tendency  to  check  secretion,  “free  cir- 
cular therapy”  to  the  contrary  notwithstanding. 

Codeina. — IT.  S. — Codein.  Very  soluble  in  al- 
cohol, much  less  soluble  in  water. 

CODEINiE  PlIOSPHAS. — U.  S. 

Codeine  Sulphas. — IT.  S. — Both  are  quite  sol- 
uble in  water,  but  not  in  alcohol. 

Average  Dose:  0.003  gm.  (3  mg.  or  1/20  grain). 

Codein,  rather  than  its  salts,  is  suited  for  com- 
bination with  terpin  hydrate,  since  both  require  al- 
cohol as  solvent. 

Codein  has  come  very  largely  into  use  in  expec- 
torant mixtures  in  recent  years,  partly  because  its 
action  resembles  that  of  morphin  without  disturb- 
ing digestion  or  causing  constipation  in  moderate 
doses,  partly,  no  doubt,  because  manufacturers 
have  popularized  it  in  order  to  avoid  the  stigma 
attaching  to  the  general  use  of  morphin  and  opium. 


EXPECTORANTS. 


233 


Coclein  undoubtedly  lessens  cough,  but,  as  al- 
ready stated,  this  is  not  always  desirable.  Codein 
phosphate  or  sulphate,  being  soluble  in  water,  may 
be  added  to  almost  any  cough  mixture  which  is 
not  alkaline. 

The  following  is  suggested  as  a simple  prescrip- 
tion containing  codein : 


R.  Codeina-  sulph grs.  viii  |5 

Ammonii  chloridi  3iss  6| 

Syrupi  pruni  virg.  q.  s.  ad §iii  100| 


M.  Sig. : A teaspoonful  every  two  or  three  hours. 

Compound  mixture  of  glyeyrrhiza,  syrup  of  tar,  syrup 
of  squill  or  syrup  of  tolu  may  be  substituted  wholly  or  in 
part,  for  the  syrup  of  wild  cherry. 

Ammonium  chlorid  is  not  well  suited  for  com- 
bination with  terpin  hydrate,  since  the  latter  re- 
quires a strongly  alcoholic  menstruum  which  pre- 
cipitates ammonium  chlorid. 

Numerous  substitutes  have  been  introduced  for 
morphin  and  codein,  but  it  has  not  been  demon- 
strated that  they  possess  all  the  advantages  and 
none  of  the  disadvantages  of  the  officials.  It  must 
not  be  forgotten  that  the  habit  may  be  formed 
with  any  of  the  morphin  derivatives,  including 
codein. 

The  bromids  of  ammonium,  potassium  and  so- 
dium are  safer  than  morphin,  and  are  frequently 
beneficial  when  anodynes  are  indicated.  Their 
doses  should,  however,  be  more  than  proportion- 
ately reduced  for  children. 

Hydrocyanic  acid  may  be  added  to  expectorant 
mixtures,  but  its  action  is  fleeting  and  it  must 
be  frequently  repeated. 

Acidum  Hydrocyanicum  Diltttum. — TJ.  S. — 
Contains  2 per  cent,  absolute  HCN. 


234 


PHARMACOPEIA  AND  PHYSICIAN. 


The  average  dose  is  0.1  c.c.  (l1/^  minims). 

DEMULCENT  EXPECTORANTS. 

Demulcents  are  frequently  employed  to  allay  the 
irritation  of  the  mucous  membrane,  and  they  pos- 
sess the  great  advantage  of  being  harmless.  They 
may  be  administered  in  the  form  of  lozenges  or 
troches. 

The  following  demulcents  may  be  used  as  ve- 
hicles : 

Syrupus  ACACIiE. — U.  S. 

Mucil ago  Acacije. — U.  S. 

Glycyrrhiza. — U.  S.- — Licorice  Boot  is  so  well 
known  as  to  require  but  little  comment.  Its  prep- 
arations afford  a variety  of  forms  for  administer- 
ing it. 

Fluidextractum  Glycyrrhiza. — U.  S. — This 
is  the  Fluidextract  of  Licorice  Boot,  from  which  a 
satisfactory  syrup  may  be  prepared  by  mixing  25 
c.c.  of  the  fluidextract  with  enough  syrup  to  make 
100  c.c. 

Average  Dose:  2 c.c.  (30  minims). 

Extractum  Glycyrrhiza  Purum. — U.  S. — 
This  is  a semi-solid  extract  prepared  from  the  root 
and  is  well  adapted  as  an  addition  to  extempora- 
neous mixtures. 

Average  Dose:  1 gm.  (15  grains). 

TrOCHISCI  GLYCYRRHIZA  ET  OpII. — U.  S. — 
These  contain  0.005  gm.  (5  mg.  or  1/12  grain) 
of  opium. 

Glycyrritizinum  Ammoniatum. — U.  S. — Am- 
moniated  Glycvrrhizin  is  an  excellent  demulcent; 
it  is  readily  soluble  in  water,  but  incompatible 
with  acids. 

Average  Dose:  About  0.25  gm.  (4  grains). 


EXPECTORANTS. 


235 


PULVJS  GLYCYRRHIZA  COMPOSITUS. — U.  S. — 
Compound  Powder  of  Glycyrrhiza,  a laxative,  con- 
taining senna,  washed  sulphur,  glycyrrhiza,  sugar 
and  oil  of  fennel,  and  is  popularly  believed  to  be  a 
desirable  adjuvant  to  expectorant  medicines. 

Average  Dose:  4 gm.  (60  grains). 

Mistura  Glycyrrhiza  Composita. — Com- 

pound Mixture  of  Glycyrrhiza,  brown  mixture,  con- 
taining purified  extract  of  glycyrrhiza  and  acacia, 
each  3 per  cent.,  syrup  5 per  cent.,  with  camphor- 
ated tincture  of  opium  12  per  cent.,  wine  of  an- 
timony 6 per  cent,  and  spirit  of  nitrous  ether  3 
per  cent. 

Average  Dose:  8 e.c.  (2  fluidrachms) . 

This  is  a deservedly  popular  expectorant.  It  is 
very  often  prescribed  alone,  but  is  also  much  used 
as  a vehicle  for  other  expectorants,  particularly 
ammonium  chlorid. 

Ammonii  Carbonas. — U.  S. — Ammonium  Car- 
bonate. This  consists  of  white,  hard,  translucent, 
striated  masses  of  a strong  odor  of  ammonia  with- 
out empyreuma,  and  a sharp,  saline  taste,  slowly 
but  completely  soluble  in  about  4 parts  of  water 
and  decomposed  by  hot  water. 

A condition  deserving  especial  mention  is  that 
in  which  the  mucus  is  particularly  thick  and  te- 
nacious, requiring  liquefaction  ; for  this  purpose, 
ammonium  carbonate  is  frequently  added  to  other 
expectorants;  it  has  the  disadvantage  of  an  un- 
pleasant taste,  which  can  not  be  disguised  with  di- 
luted acids  because  these  decompose  the  carbon- 
ates. 

The  cough  of  chronic  bronchitis  requires  the 
use  of  one  of  the  stimulant  expectorants,  such  as 
terebene  or  terpin  hydrate,  bearing  in  mind  the 


236 


PHARMACOPEIA  AND  PHYSICIAN. 


avoidance  of  those  which  will  prove  objectionable 
with  continued  use. 

While  urging  the  advantage  of  using  the  phar- 
macopeial  expectorants,  we  particularly  suggest 
that  the  physician  consider  the  several  ingredients 
of  any  nostrum  instead  of  accepting  the  absurd  and 
often  grotesque  claims  of  the  manufacturer. 


CHAPTER  X. 


ANALGESICS  AND  SOPORIFICS. 

Analgesics  and  soporifics  are  among  the  most 
important  articles  in  the  materia  medica,  and  at 
the  same  time,  owing  to  their  abuse,  among  the 
most  harmful. 

Pain,  accompanied  by  sleeplessness,  occurs  in  a 
great  variety  of  conditions,  often  with  an  inten- 
sity or  persistency  that  imperatively  demands  alle- 
viation. When  such  a condition  requires  medi- 
cines for  a long  time  there  is  danger  that  the  pa- 
tient will  learn  the  name  of  the  remedy  employed 
and  continue  its  use  after  the  actual  necessity  for 
it  has  passed.  Certainly  no  other  class  of  reme- 
dies requires  more  painstaking  care  on  the  part 
of  the  physician,  not  only  in  the  choice  of  the  par- 
ticular agent  to  be  used,  but  also  in  the  regulation 
of  the  dose. 

The  way  to  secure  the  best  results  in  the  treat- 
ment of  such  conditions  is  by  acquiring  an  inti- 
mate knowledge  of  the  ~ various  remedies  in  this 
class  and  by  learning  how  to  use  them  singly  or 
in  combination  as  may  be  required. 

In  a given  case  a combination  of  hyrated  chloral 
and  potassium  bromid  may  be  necessary,  while  in 
another  the  latter  alone  may  suffice.  The  more 
dangerous  hydrated  chloral  should  never  be  used 
when  the  less  harmful  bromid  will  serve  the  pur- 
pose.1 


1.  Should  the  physician  desire  to  use  a compound  mixture 
of  hydrated  chloral  and  potassium  bromid  of  the  bromidia 


238 


PHARMACOPEIA  AND  PHYSICIAN. 


If  we  find  that  scarcely  any  two  successive  pa- 
tients demand  exactly  the  same  prescription  of  but 
two  ingredients,  how  very  much  less  is  the  proba- 
bility of  finding  any  considerable  number  each  re- 
quiring a “shotgun”  prescription  of  five  or  six 
substances  of  widely  different  action,  agreeing  only 
in  the  one  property  of  producing  unconscious- 
ness. 

It  should  be  obvious  that  the  conscientious  use 
of  analgesics  and  soporifics  demands  the  thought- 
ful selection  of  the  remedy  with  the  careful  com- 
putation of  the  dose  according  to  the  necessities 
of  the  individual  case — a condition  manifestly  im- 
possible when  one  relies  on  complex,  ready-made 
mixtures,  with  doses  and  indications  suggested  by 
an  interested  layman — the  manufacturer.  The 
greater  the  number  of  individuals  who  acquire 
such  harmful  habits  the  greater  are  the  profits  of 
the  nostrum  maker. 

It  is  well  known  that  the  habitual  use  of  opium, 
hydrated  chloral,  the  bromids  and  other  narcotics 


type  he  may  have  the  “Mistura  Chloralis  et  Potassii  Bromidi 
Composita”  of  the  National  Formulary  compounded,  as  fol- 
lows : 


R.  Chlorali  hydratis 

Potassii  bromidi,  aa 3i-gr.  xv 

Ext.  eannab.  ind. 

Ext.  hyoscyami,  aa gr.  % 04 

Aquas  q.  s.  ad 3vi 

The  hydrated  chloral  and  the  potassium  bromid  are  dis- 
solved in  a little  water  and  the  extracts  are  then  dissolved 


in  the  solution  of  the  salts  mixed  with  some  powdered  pumice 
stone,  and  the  mixture  filtered. 

Each  teaspoonful  will  contain  approximately  1 gm.  (15 
grains)  each  of  hydrated  chloral  and  potassium  bromid ; 
0.008  gm.  (Vs  gr.)  each  of  extract  of  Indian  cannabis  and 
extract  of  hyoscyamus. 

The  mixture  should  be  used  with  caution,  and  it  will 
usually  be  found  advantageous  to  omit  the  extract  of  Indian 
cannabis. 


This  mixture  is  unscientific  in  the  extreme  and  we  do  not 
commend  its  use. 


ANALGESICS  AND  SOPORIFICS. 


239 


is  widespread,  but  there  are  few  who  appreciate 
the  full  extent  of  these  practices,  or  in  how  far 
physicians  are  responsible  because  of  the  careless 
use  of  these  agents,  either  in  simple  form  or  as  an 
ingredient  of  some  nostrum. 

For  more  convenient  consideration  we  shall  di- 
vide these  remedies  into  the  opium,  atropin,  ace- 
tanilid,  hyrated  chloral  and  bromid  groups,  the 
first  three  being  more  properly  analgesics  and  the 
last  two  soporifics,  though  no  absolute  distinction 
can  be  drawn  between  them. 

The  widespread  use  of  opium  and  morphin  for 
local  action— injections  and  lotions — is  based  on 
an  erroneous  idea.  Opium  contains  gum  which  is 
a demulcent,  a rather  expensive  one,  however, 
while  its  active  principle,  morphin,  must  be  ab- 
sorbed before  it  can  produce  its  effects,  which  are 
constitutional,  not  local. 

OFFICIAL  PREPARATIONS  OF  OPIUM. 

The  importance  of  opium  and  morphin  are  such 
that  their  actions  and  uses  should  be  carefully 
studied  in  standard  works  of  the  day,  and  we  shall 
pass  to  the  minor  members  of  the  group  after 
enumerating  the  official  preparations. 

The  danger  that  the  patient  will  form  the  truly 
terrible  opium  habit  from  even  a short  use  of  the 
drug  or  of  any  of  its  derivatives  should  always 
be  borne  in  mind,  and  when  it  is  necessary  to  use 
them  they  should  be  masked.  Hypodermics  in 
pain  have  come  to  be  almost  synonymous  with  mor- 
phin  in  the  minds  of  the  laity.  This  idea  should 
be  uprooted  both  by  the  use  of  the  method  for 
many  other  substances  and  by  avoiding  it  as  much 
as  possible  with  morphin.  The  odor  and  the  taste 


240 


PHARMACOPEIA  AM)  PHYSICIAN. 


of  opium  and  of  the  tincture,  unfortunately,  are 
well  known  and  they  should  be  disguised  if  possi- 
ble. 

To  disguise  the  identity  of  opium  and  its  prep- 
arations it  is  customary  with  some  practitioners  to 
employ  the  old  designation  thebaica  for  opium, 
tincture  thebaica  for  the  tincture.  The  use  of  the 
deodorized  preparations  of  opium  is  also  to  be  rec- 
ommended for  this  same  purpose. 

The  official  titles,  properly  coming  under  the 
heading  opium,  are  not  only  numerous,  but  varied 
and  important.  Opium  and  granulated  opium  are 
never  used  directly  in  the  practice  of  medicine,  but 
powdered  opium  and  deodorized  opium  are  fre- 
quently prescribed. 

Opii  Pulyis. — IT.  S. — When  assayed,  by  the 
process  given  in  the  Pharmacopeia,  this  should 
yield  not  less  than  12  per  cent,  nor  more  than  12.5 
per  cent,  of  crystallized  morphin.  This  require- 
ment is  somewhat  higher  than  the  provision 
adopted,  for  the  International  Standard,  which 
limits  the  morphin  contents  of  powdered  opium  to 

10  per  cent. 

Average  Dose : IT.  S.  P.  powdered  opium  is 

0.050  (50  mg.  or  1 grain). 

Opium  Deodoratum.2 — IT.  S. — This  is  pow- 
dered opium  which  has  been  treated  with  purified 
petroleum  benzin  to  remove  the  caoutchouc,  wax, 

011  and  the  odorous  substances  that  are  present; 
the  alkaloidal  strength  and  the  dose  of  deodorized 

2.  This  preparation  is  superior  to  the  widely  used  pro- 
prietary preparation  of  opium  “Svapnia.”  over  which  it  has 
the  advantage  of  economy,  activity  and  even  general  reliabil- 
ity, since  the  accompanying  directions  for  assay  are  not 
alone  accurate,  but  are  readily  followed  by  any  one  versed 
in  chemical  assay  work. 


ANALGESICS  AND  SOPORIFICS. 


241 


opium  are  the  same  as  for  the  official  powdered 
opium. 

Extractum  Opii. — TJ.  S. — Assayed  to  contain 
20  per  cent,  of  morphin.  This  preparation  is  now 
little  used,  except  in  suppositories  and  the  official 
opium  plaster. 

Average  Dose:  0.030  gm.  (30  mg.  or  % grain). 

Pin: la:  Opii. — U.  S. — These  are  each  composed 
of  opium,  0.065  (1  grain),  and  soap  0.020  (1/3 
grain ) . These  pills  constitute  a very  ancient  form 
of  administering  opium. 

There  are  five  liquid  preparations,  the  least  use- 
ful of  which  will  be  mentioned  first : 

Yinum  Opii. — U.  S. — Containing  10  per  cent, 
of  opium  in  fortified  white  wine,  aromatized  with 
1 per  cent.,  each,  of  cinnamon  and  cloves.  It  re- 
sembles the  well-known  “Laudanum  of  Syden- 
ham.” 

Average  Dose:  0.5  c.c.  (8  minims). 

Acetum  Opii. — IT.  S. — Vinegar  of  Opium,  for- 
merly known  as  black  drop,  Lancaster  drops  or 
Quaker  drops,  has  long  been  known  and  extensively 
used.  It  contains  10  per  cent,  of  opium  and  3 per 
cent,  of  nutmeg  in  diluted  acetic  acid,  sweetened 
with  sugar. 

Average  Dose:  0.5  c.c.  (8  minims). 

Tinctura  Opii. — L.  S. — Tincture  of  Opium  is 
the  well-known  and  widely  used  laudanum,  and 
consists  of  10  per  cent,  of  opium  in  diluted 
alcohol. 

Average  Dose:  0.5  c.c.  (8  minims). 

Tinctura  Opii  Camphorata. — TJ.  S. — This, 
also  known  as  paregoric  or  paregoric  elixir,  is  the 
only  one  of  the  compound  preparations  of  opium 
now  official.  It  is  so  well  known  as  a mild  anodyne 


242  PHARMACOPEIA  AND  PHYSICIAN. 

and  sedative  that  further  notice  is  not  necessary. 

Average  Dose:  8 c.c.  (2  fluidrams).  This 

amount  contains  about  0.03  gm.  ( )/£>  grain),  each, 
of  powdered  opium,  benzoic  acid,  camphor  and  oil 
of  anise. 

Tixctura  Opii  Deodorati. — U.  S. — Deodor- 
ized Tincture  of  Opium  is  practically  a 10  per  cent, 
aqueous  extract  of  opium  that  has  been  treated 
with  purified  petroleum  benzin  to  remove  the  odor- 
ous and  other  objectionable  constituents,  and  sub- 
sequently preserved  by  the  addition  of  20  p£r 
cent,  of  alcohol.  This,  like  the  simple  tincture  of 
opium,  is  directed  to  yield,  on  assay,  not  less  than 
1.2  per  cent,  nor  more  than  1.25  per  cent,  of  mor- 
phin  in  crystals.  The  average  dose  is  0.5  c.c.  (8 
minims) . While  there  has  been  some  controversy  as 
to  who  originated  this  particular  preparation,  there 
has  never  been  any  difference  of  opinion  as  to  its 
possibilities  and  uses.  From  the  sedative  elixirs  of 
nearly  a century  ago  to  the  Scotch  oats  essence  of 
the  present  day  there  have  been  many  attempts  to 
exploit  deodorized  or  masked  opium  preparations, 
as  harmless  vegetable  compounds.  Another  class 
of  preparations,  like  “McMunn’s  Elixir  of  Opium,” 
has  been  exploited  as  embodying  some  wonderful 
discovery  in  the  treatment  of  opium.3  The  official 
deodorized  tincture  is  in  every  way  distinctly  su- 
perior to  all  of  these  nostrums,  because,  as  noted 

3.  “Papine”  would  be  a gem  among  these  if  the  claims 
made  for  it  were  true,  hut  we  can  not  believe  that  any  prep- 
aration of  opium  “containing  the  pain  relieving  principle 
(which  we  know  to  be  morphin)  can  be  “a  safe  opiate  for 
children  under  one  year.”  This  affords  a good  example  of 
the  audacity  of  the  nostrum  vendor  who  seeks  to  delude 
the  physician  and  induce  him  to  foster  such  vicious  habits 
even  in  the  cradle. 


ANALGESICS  AND  SOPORIFICS. 


243 


under  deodorized  opium,  it  has  the  advantage  of 
economy,  efficiency  and  reliability. 

There  are  but  three  other  galenical  preparations 
of  opium  official  in  the  present  Pharmacopeia. 

Tinctura  Ipecacuanha  et  Opii. — U.  S. — 
Liquid  Dover’s  powder.  This  is  of  practically  the 
same  strength  as  the  well-known  powder  of  ipecac 
and  opium. 

Average  Dose:  0.5  e.c.  (8  minims). 

Pul  vis  Ipecacuanha  et  Opii. — U.  S. — This 
has  been  noticed  under  ipecac  (see  Chapter  IX). 
It  contains  10  per  cent.,  each,  of  ipecac  and  of  pow- 
dered opium. 

Average  Dose:  0.500  gm.  (7^2  grains). 

Trochisci  Glycyrrhiza  et  Opii. — U.  S. — 
These  have  been  previously  noticed. 

MORPHIN  AND  CODEIN. 

The  alkaloids,  morphin  and  codein,  are  of  nearly 
as  much  interest  as  opium. 

Morphin  was  discovered  by  Sertiirner,  a German 
apothecary,  in  1805,  and  was  used  in  medicine  as 
early  as  1820.  There  are  four  official  prepara- 
tions : 

Morphina. — U.  S. — This  alkaloid,  obtained 
from  opium,  occurs  as  colorless  or  white  shining 
rhombic  prisms  or  as  fine  needles  or  as  a crystal- 
line powder.  It  is  odorless  and  has  a bitter  taste. 

Average  Dose  : 0.010  gm.  (1/5  grain). 

Morphina  Acetas. — U.  S. — This  salt  of  mor- 
phin should  be  kept  in  well-stoppered,  dark  amber- 
colored  bottles,  and  a minute  quantity  of  free  ace- 
tic acid  should  be  present  to  prevent  decomposi- 
tion. 

Average  Dose:  0.015  gm.  (^4  grain). 


244 


PHARMACOPEIA  AXD  PHTSICIAy. 


Morphine  Hydrochloridum. — U.  S. — Like 
the  acetate,  this  should  be  kept  in  well-stoppered 
dark  bottles. 

Average  Dose:  0.015  gm.  grain). 

Morphines  Sulphas. — U.  S. — Like  the  other 
morphin  salts,  this  should  be  kept  in  well-stop- 
pered  dark  bottles. 

Average  Dose:  0.015  gm.  ()4  grain). 

Sulphate  of  morphin  is  much  the  most  fre- 
quently used  in  this  country,  while  the  hydro- 
chlorid  is  generally  given  the  preference  in  Eu- 
rope. The  acetate  is  the  most  readily  soluble  in 
water  but  is  quite  unstable,  losing  acetic  acid  on 
exposure  to  the  air,  and,  as  the  alkaloid  morphin 
requires  3,300  parts  of  the  water  for  solution  at 
ordinary  temperatures,  considerable  care  should  be 
exercised  in  the  use  of  old.  and  possibly  decom- 
posed, samples  of  morphin  acetate. 

While  the  new  Pharmacopeia  gives  0.015  gm. 
(14  grain)  as  the  average  dose  of  the  salts  of 
morphin.  we  believe  that  this  is  too  high  as  the 
“average”  dose. 

Codein  and  two  of  its  salts  are  official : Codeina, 
codeina?  phosphas,  codeinfe  sulphas. 

Codein,  in  addition  to  being  obtained  from 
opium,  is  also  prepared  from  morphin  by  methyl- 
ation.  It  was  discovered  by  a French  chemist.  E. 
Robiquet,  in  1832.  but  was  not  generally  used  in 
the  practice  of  medicine  until  many  years  later. 
It  was  admitted  into  the  IT.  S.  Pharmaeoepia  in 
1880;  the  phosphate  and  the  sulphate  are  now 
official  for  the  first  time.  The  sulphate  is  the  form 
most  frequently  employed  in  this  country,  though 
it  appears  to  be  but  little  known  abroad,  where 
the  phosphate  is  mainly  used.  The  phosphate  was 


ANALGESICS  AND  SOPORIFICS. 


245 


considered  under  ‘‘Expectorants.”  Codein  has  been 
considered  a somewhat  uncertain  drug,  owing  to  its 
frequent  contamination  with  morphin,  but  the 
Pharmacopeia  provides  a test  for  its  purity,  and 
particularly  for  detecting  the  presence  of  the  more 
poisonous  alkaloid. 

The  phosphate  being  readily  soluble  in  2.5  parts 
of  water,  is  particularly  well  suited  for  hypoder- 
mic use;  or  it  may  be  prescribed  alone  in  syrup  or 
combined  with  hydrated  chloral  or  the  bromids ; in 
the  latter  case  the  mixture  should  be  directed  to 
be  shaken  before  using. 

The  average  dose  of  codein  or  of  any  of  its  salts 
is  0.03  gm.  (30  mg.  or  % grain). 

Apomorphi^l®  Hydro  chloridum. — IT.  S. — 
which  was  also  mentioned  under  “Expectorants,” 
has  been  recently  brought  to  notice  as  a hypnotic, 
in  doses  of  0.002  (1/30  grain).  It  is  said  to  have 
the  great  advantage  of  not  producing  a drug  habit. 

Heroin  and  dionin  are  proprietary  articles  of  the 
morphin  group  possessing  some  advantages,  but 
they  are  not  free  from  danger.  The  heroin  habit 
is  beginning  to  be  common  and  should  be  carefully 
guarded  against. 

Cannabis  Ixdica. — U.  S. — Indian  Cannabis  is 
a well-known  member  of  the  opium  group.  It 
occurs  in  dark-green  or  brownish  compressed 
masses,  having  an  agreeable  narcotic  odor  and 
characteristic  taste. 

It  appears  to  have  been  used  by  the  Hindoos 
from  very  early  time.  It  was  also  known  to  the 
Egyptians  and  to  Dioscorides,  but  it  was  not  intro- 
duced into  England  until  about  1835. 

Average  Dose:  0.05  gm.  (1  grain),  but  rarely 
used  in  substance. 


24G 


PHARMACOPEIA  AND  PHYSICIAN. 


Extractum  Cannabis  Indict. — U.  S. 

Average  Dose:  0.05  c.c.  (1  minim). 

Pinctura  Cannabis  Indicje. — U.  S. — repre- 
sents 10  per  cent,  of  the  drug  extracted  with  alco- 
hol. 

Average  Dose:  0.5  c.c.  (10  minims). 

At  one  time  the  cannabis  indica  was  supposed  to 
have  great  virtues  as  an  antispasmodie,  analgesic 
and  narcotic,  and  it  was  highly  recommended  by 
a few  physicians  as  a vasomotor  stimulant,  uterine 
stimulant,  etc.  It  is  now  but  little  used  and  there 
seem  to  be  few  conditions  in  which  one  of  the  prep- 
arations of  opium  could  not,  advantageously,  be 
used  in  its  stead.4 

Two  other  members  of  the  opium  group  are 
sanguinaria,  which  we  have  had  occasion  to  men- 
tion elsewhere,  and  the  feebly-acting 

Lactucarium. — U.  S. 

Average  Dose:  1 gm.  (15  grains). 

Tinctura  Lactucarii. — U.  S. — This  is  a 50 

4.  It  may  be  worth  while  to  notice  the  importance  attached 
to  the  extract  of  cannabis  indica  by  the  makers  of  bromidia, 
who  claim  that  their  preparation  is  the  only  hypnotic  that 
has  stood  the  test  in  every  country  for  thirty  years.  Since 
all  the  other  constituents  are  very  commonly  used,  one  must 
infer  that  they  consider  the  “genuine  imported  extract  of 
cannabis  Indica  of  exceptional  value.  Bromidia,  it  is  claimed 
by  the  manufacturer,  contains  15  grains  each  of  hydrated 
chloral  and  potassium  bromid,  and  % grain  each  of  genuine 
imported  extract  of  cannabis  indica  and  extract  of  hyoscya- 
mus,  to  the  teaspoonful.  Thus  a single  repetition  of  the  dose 
— one  teaspoonful — might  prove  fatal,  since  30  grains  of 
hydrated  chloral  have  caused  death  ; but  the  manufacturers 
advise  hourly  doses  so  long  as  may  be  necessary  to  Induce 
sleep.  The  extravagant  claims  made  by  the  manufacturers 
of  this  nostrum  have  Induced  many  physicians  to  use  It  in 
preference  to  prescribing  the  several  official  constituents  ac- 
cording to  Individual  needs,  and  to-day  it  is  offered  direct 
to  the  public  at  cut-rate  prices. 


ANALGESICS  AND  SOPORIFICS. 


247 


per  cent,  solution  of  lactucarium  in  diluted  alcohol. 

Average  Dose:  2 c.c.  (30  minims). 

Syrupus  Lactucarii. — U.  S. — This  is  much 
more  commonly  employed  than  the  tincture,  its 
popularity  being  largely  due  to  a nostrum. 

Average  Dose : 8 c.c.  (2  fluidrams) . 

THE  ATROPIN  GROUP. 

The  atropin  group  includes  the  crude  drugs 
yielding  the  mydriatic  alkaloids,  such  as  atropin, 
hyoscyamin  and  hyoscin,  or  scopolamin,  all  of  the 
latter  being  closely  related  chemically. 

The  actions  of  atropin  and  its  congeners  are  so 
important  and  so  complex  that  it  is  entirely  beyond 
the  scope  of  the  present  article  to  attempt  any- 
thing like  a complete  description  of  them.  The 
reader  can  not  avail  himself  of  this  potent  and  im- 
portant class  of  agents  without  a careful  study  of 
their  pharmacologic  and  therapeutic  actions.  We 
shall,  therefore,  call  attention  to  a few  more  im- 
portant applications  and  contraindications  without 
entering  deeply  into  the  reasons. 

Atropin  is  useful  as  an  analgesic  mainly  when 
the  pain  is  of  spasmodic  origin  and  when  the  appli- 
cation may  be  made  directly  to  the  nerve  ends  of 
the  affected  tissues.  In  the  pains  of  lead  colic 
this  may  be  accomplished  by  the  internal  use  of 
one  of  the  preparations  of  belladonna,  preferably  a 
pill  of  the  extract  coated  with  salol  or  keratin. 

The  most  prominent  action  of  atropin  is  seen  in 
the  dilation  of  the  pupil,  but  the  more  rapidly  act- 
ing and  less  enduring  homatropin  hydrochlorid  is 
usually  preferred  for  this  purpose,  if  the  object  is 
merely  to  examine  the  eye — atropin,  if  it  is  de- 


248 


PHARMACOPEIA  AND  PHYSICIAN. 


sired  to  paralyze  accommodation  for  some  time,  as 
in  inflammatory  conditions. 

While  the  mydriatic  effect  is  so  similar  with  the 
different  members  of  this  group,  it  must  be  remem- 
bered that  they  have  very  dissimilar  actions  on  the 
brain. 

The  crude  drugs  and  their  preparations  belong- 
ing to  this  class  are  so  numerous  and  so  well  known 
that  it  is  hardly  necessary  to  enumerate  them.  Be- 
sides Belladonna  Boot  and  Leaves,  Hyoscyamus 
and  Stramonium  Leaves,  a member  now  official  for 
the  first  time,  is  Scopola. 

Scopola. — U.  S. — The  dried  rhizome  of  Scopola 
carniolica  (Jacquin)  (Fam.  Solanacece) , yielding, 
when  assayed  as  directed  in  the  Pharmacopeia, 
not  less  than  0.5  per  cent,  of  its  alkaloids,  has  little 
odor  and  a sweetish,  afterward  bitterish,  acrid 
taste.  Though  described  by  Dr.  Scopoli  in  1771, 
it  attracted  but  little  attention  from  the  medical 
profession  until  it  was  used  in  manufacturing 
“belladonna”  plasters. 

Average  Dose:  0.04  gm.  (2/3  grain). 

Fluidextractum  Scopola. — IT.  S. 

Average  Dose:  0.05  c.c.  (1  minim). 

Scopolamine  Hydrobromidum. — IT.  S. — This 
is  chemically  identical  with  Hyoscins  Hydrobrom- 
idum I".  S. 

It  has  been  used  in  the  treatment  of  nervous 
excitement,  particularly  of  the  insane.  It  often 
induces  quiet  sleep  at  night — not  usually  in  the 
day — and  may  also  lessen  sexual  excitement. 
Atropin,  on  the  other  hand,  has  been  used  to  stim- 
ulate the  brain  in  cases  of  depression. 

Average  Dose:  0.0005  gm.  (0.5  mg.  or  1/125 

grain) . 


ANALGESICS  AX  I)  SOPORIFICS. 


249 


Hyoscyaminje  Hydrobromidum,  U.  S.,  and 

HyoscyamiilJ  Sulphas. — II.  S. — These  are 
used  very  much  as  Hyoscin  is. 

Average  Dose:  0.005  gm.  (0.5  mg.  or  1/120 

grain) . 

None  of  the  mydriatic  alkaloids  should  be  used 
as  soporifics  except  in  case  of  urgent  need,  as  the 
benefits  may  be  more  than  counterbalanced  by  the 
disadvantages.  Hyoscin  and  hyoscyamin  are  of  lit- 
tle use  directly  in  relieving  pain;  hence,  they  can 
hardly  be  considered  as  analgesics. 

Any  of  these  alkaloids  may  be  given  alone  as 
tablet  triturates  or  as  compressed  tablets,  hypoder- 
mically or  alone  in  aqueous  solution. 

The  following  is  a common  method  of  exhibit- 
ing belladonna,  particularly  in  asthma : 

It.  Tinctur*  belladonnas  fol. 

Tincturse  lobelise,  of  each 3ii  10 1 

Spiritus  aetheris  nitrosi,  q.  s.  ad.  . . 3iii  100 1 

Of  this  a teaspoonful  is  given  every  hour  or  two 
until  relief  is  obtained. 

The  bromids  of  ammonium,  sodium  or  potas- 
sium may  be  used  with  the  prescription  given,  but 
in  that  case  adjuvant  or  aromatic  elixir  should  be 
substituted  for  the  spirit  of  nitrous  ether,  and,  as 
in  every  case  when  bromids  or  iodids  are  combined 
with  alkaloids,  the  mixture  is  directed  to  be 
shaken. 

The  extracts  of  the  crude  drugs  are  much  to  be 
preferred  to  the  alkaloids  as  additions  to  purga- 
tives, since  the  latter  would  be  largely  absorbed 
from  the  stomach,  whereas  the  local  action  on  the 
intestine  is  desired. 


250 


PHARMACOPEIA  AND  PHYSICIAN. 


THE  ACETANILID  GROUP. 

The  enormous  growth  of  the  traffic  in  proprie- 
tary remedies  mainly  composed  of  acetanilid  and 
allied  substances  is  probably  the  most  potent  fac- 
tor in  arousing  physicians  to  a realization  of  the 
part  they  play — often  unconsciously — in  further- 
ing the  selfish  schemes  of  unprincipled  manufac- 
turers. The  Council  on  Pharmacy  and  Chemistry 
of  the  American  Medical  Association  has  shown 
that  antikamnia,  phenalgin,  salacetin  and  am- 
monol  are  mere  mixtures  of  acetanilid  with  other 
substances,  and  we  can  no  longer  prescribe  these 
acetanilid  mixtures  under  the  impression  that  we 
are  using  true  chemical  compounds.  It  is  probable 
that  acetanilid  figures  more  extensively  in  self- 
drugging  than  does  any  other  single  substance. 

The  following  are  official : 

Acetanilidum. — U.  S. — Acetanilid,  antifebrin, 
phenylacetamid,  the  monacetyl  derivative  of  anilin, 
occurs  in  colorless  crystalline  laminae  or  powder, 
permanent  in  air,  odorless,  of  a slightly  burning 
taste,  and  very  slightly  soluble  in  water. 

In  was  first  prepared  by  Gerhard  in  1852,  but 
was  not  used  medicinally  until  nearly  thirty  years 
later,  when  it  was  introduced  under  the  trade- 
mark name  of  antifebrin.  It  is  now  employed 
very  extensively,  its  extreme  cheapness — less  than 
2 cents  an  ounce — causing  it  to  be  used  as  the  basis 
of  many  pretended  synthetics. 

Average  Dose:  0.20  gm.  (3  grains). 

Pulvis  Acetanilidi  Composites. — U.  S. — 
This  has  been  made  official  to  serve  as  a substitute 
of  uniform  standard  for  the  host  of  more  or  less 
similar  compounds,  such  as  we  have  enumerated 


ANALGESICS  AND  SOPORIFICS. 


251 


above,  which  have  come  into  such  unfortunate 
vogue. 

The  official  preparation  consists  of  70  per  cent, 
of  acetanilid,  10  per  cent,  of  caffein  and  20  per 
cent,  of  sodium  bicarbonate. 

Average  Dose:  0.3  gm.  (5  grains). 

Acetphenetidinum. — U.  S. — Acetphenatidin, 
better  known  as  phenacetin,  is  official  in  the  Brit- 
ish, German  and  other  European  pharmacopieas 
as  Phenacetinum.  It  is  officially  described  as  Acet- 
para-phenetidin,  a phenol  derivative,  the  product 
of  the  acetylization  of  para-amido-phenetol. 
Phenacetin  occurs  as  white  glistening  scales  or  a 
tine  crystalline  powder,  odorless  and  nearly  taste- 
less. It  is  soluble  in  925  parts  of  water  and  in  12 
parts  of  alcohol. 

Antipyrinum. — U.  S. — Antipyrin  is  official  in 
France  as  Analgesin,  in  Great  Britain  as  Phena- 
zonum,  and  in  Germany  as  Pyrazolonum — phenvl- 
dimethylicum.  Chemically,  it  is  described  as 
phenyl-dimethyl-pyrazolon,  and  is  obtained  by  the 
condensation  of  phenyl-hydrazin  with  aceto-acetic 
acid  and  subsequent  methylation  of  the  product. 
Antipyrin  occurs  as  a colorless,  almost  odorless, 
bitter  tasting,  crystalline  powder,  that  is  readily 
soluble  in  water  and  soluble  in  about  1 part  of 
alcohol. 

5.  It  should  be  noticed  that  the  dope  of  acetanilid  in  the* 
mixture  is  larger  than  the  official  dose  of  acetanilid ; yet 
it  is  supposed  to  act  more  effectively  when  mixed  with  so- 
dium bicarbonate.  It  is  to  be  regretted  that  such  a combi- 
nation has  been  given  official  recognition.  The  reason,  of 
course,  is  evident — persistent  advertising  of  certain  nostrums 
has  created  an  abnormal  demand  for  acetanilid  combined  with 
a supposed  heart  stimulant.  But,  as  it  Is  extremely  improb- 
able that  caffein  does  counteract  the  harmful  effects  of 
acetanilid,  it  is  not  wise  to  recognize  such  a combination 
even  to  meet  a supposed  demand. 


252 


PHARMACOPEIA  AND  PHYSICIAN. 


Average  dose:  0.250  gm.  (4  grains). 

Antipyrin  was  first  prepared  by  Dr.  L.  Ivnorr  of 
Erlangen,  in  1884;  it  was  investigated  physiologic- 
ally by  Professor  Filehne,  who  reported  it  as  an 
active  antipyretic. 

It  will  be  more  satisfactory  to  consider  the 
therapeutics  of  these  antipyretics  collectively,  with 
occasional  comments  on  the  separate  members  of 
the  group. 

They  are  mostly  used  for  headache  and  for  the 
reduction  of  temperature  in  fevers  of  an  intermit- 
tent type,  but  it  must  not  be  forgotten  that  they 
do  not  remove  the  underlying  cause,  and  that  the 
use  of  these  drugs  in  continued  fevers  is  liable  to 
be  harmful,  since  the  temperature  is  sure  to  return 
to  its  former  height,  or  to  go  even  higher,  when  the 
action  of  the  antipyretic  has  worn  off. 

The  alarming  collapse  that  may  follow  even  a 
moderate  dose  of  acetanilid  serves  as  a warning 
against  its  use  when  there  is  reason  to  suspect  any 
tendency  to  that  condition.  On  the  other  hand,  a 
sudden  lowering  of  the  temperature  in  fever  may 
result  in  collapse  symptoms  wholly  independently 
of  the  nature  of  the  remedy  employed.  Acetanilid 
has  the  greatest  and  phenacetin  the  least  tendency 
to  produce  collapse  among  the  official  preparations 
of  this  nature.  It  is  to  overcome  this  tendency 
that  caffein  is  used  in  the  official  compound  acetan- 
ilid powder,  but  it  is  doubtful  if  it  is  of  any  great 
value  in  guarding  against  this  collapse.  There  can 
be  little  doubt  that  many  of  the  sudden  deaths,  of 
which  we  so  constantly  read,  occurring  without  ap- 
parent cause  on  the  streets  and  elsewhere,  are  in 
reality  due  to  overdosing  with  nostrums  containing 
acetanilid. 


ANALGESICS  AND  SOPORIFICS. 


253 


Women  should  be  particularly  cautioned  against 
the  promiscuous  use  of  nostrums  of  this  type  dur- 
ing menstruation. 

When  it  is  remembered  that  antipyrin  and  ace- 
tanilid  are  derived  from  phenylhydrazin,  and 
anilin — active  blood  poisons — it  is  not  surprising 
that  the  official  derivatives  possess  the  properties 
of  these  drugs  in  a minor  degree. 

A peculiar  cyanosis  is  often  seen  about  the  ears, 
the  lips  and  the  nails,  particularly  after  large  doses 
of  acetanilid,  due  to  its  action  on  the  red  blood 
cells ; this  has  been  noticed  even  in  the  absence  of 
hemoglobin  in  the  blood. 

Acetanilid  in  large  doses  causes  destruction  of 
red  blood  cells,  and  methemoglobin  may  be  thrown 
into  the  plasma. 

The  collapse  seen  after  ingestion  of  the  anti- 
pyretics, particularly  acetanilid  (least  with  phen- 
acetin)  is  due  to  several  causes.  Probably  the  most 
frequent  cause  is  the  mere  lowering  of  the  temper- 
ature which  exposes  the  collapse  actually  existing 
but  hidden  by  the  high  temperature.  This  result 
is  not  to  be  charged  to  the  antipyretic.  It  is 
treated  exactly  as  collapse  from  any  other  cause 
would  be — by  stimulation.  Yery  large  doses  of  the 
antipyretics  act  on  the  heart  muscle,  causing  de- 
pression. and  on  the  vasomotor  center,  causing  col- 
lapse. 

The  acetanilid  habit  is  not  rare  and  it  leads  to  a 
deplorable  condition,  but  the  symptoms  generally 
disappear  when  the  drug  is  withdrawn. 

Profuse  perspiration  is  a disagreeable  effect, 
more  frequently  seen  after  acetanilid  and  anti- 
pyrin than  after  phenacetin.  If  this  is  so  annoy- 
ing as  to  demand  interference,  a hypodermic  in- 


254 


PHARMACOPEIA  AND  PHYSICIAN. 


jection  of  0.5  mg.  (1/150  grain)  of  atropin  will 
be  found  effective.  Bedness  and  irritation  of  the 
skin  are  frequently  seen  after  the  use  of  the  various 
antipyretics  of  this  group.  They  are  probably  due 
to  vasomotor  changes. 

Antipyrin  in  solution  has  been  used  extensively 
to  check  the  bleeding  of  superficial  wounds,  and  all 
the  various  members  of  this  group  are  to  some  ex- 
tent antiseptic. 

While  so  much  space  has  been  devoted  to  the 
contraindictions  and  untoward  effects  of  these 
agents,  it  is  not  with  a view  of  discouraging  their 
use,  but  rather  that  the  physician  may  avoid  the 
disappointments  which  arise  from  their  use  in  un- 
favorable conditions. 

Acetanilid  may  be  given  alone  in  powder  or  in 
capsules,  in  adjuvant  or  aromatic  elixir,  or  sus- 
pended in  syrup  or  mucilage  of  acacia.  The  com- 
pound acetanilid  powder  affords  a convenient  form 
for  the  relief  of  headache.  A dose  of  0.3  gm.  (5 
grains)  in  powder  or  capsule  is  usually  effective; 
this  may  be  repeated  once  in  an  hour  if  necessary, 
but  further  repetition  is  to  be  avoided. 

Compressed  tablets  of  such  insoluble  substances 
as  phenacetin  and  acetanilid  are  not  recommended 
as  they  disintegrate  slowly. 

An  acetanilid  powder,  containing  ammonium 
carbonate  instead  of  caffein,  is  used  in  the  German 
Hospital  of  Philadelphia,6  when  it  is  desired  to 
avoid  the  cerebral  stimulation  of  caffein. 

6. 

R.  Acetanilid 

Sodii  bicarb.,  of  each  grs.  xxii  1 1 5 

Ammon,  carb  aa grs.  xi  |75 

This  is  sufficient  for  ten  powders  of  about  0.3  gm.  (5 
grains)  each,  one  being  given  every  three  or  four  hours  to 
reduce  fever.  For  headache  one  is  given  and  repeated,  if 
necessary,  in  an  hour. 


ANALGESICS  AND  SOPORIFICS. 


255 


Antipyrin  is  very  soluble  in  water  and  in  alco- 
hol, and  hence  it  may  be  given  in  simple  aqueous 
solution,  in  aromatic  elixir  or  in  powdered  form. 

Acetphenetidinum  (phenacetin),  being  less  ob- 
jectionable than  acetanilid  and  antipyrin,  may  be 
expected  to  replace  them  very  largely  now  that  the 
price  is  reduced.  Its  insolubility  in  water  has  led 
to  its  extensive  use  in  powder  and  in  capsules. 

A combination  of  phenacetin,  caffein  and  sodium 
bromid  has  attained  considerable  popularity;  these 
may  be  combined  in  various  ways.i. * * * * * 7 

CHEMISTRY  OF  THESE  PREPARATION'S. 

A brief  review  of  the  chemistry  of  the  antipy- 
retic group  will  show  the  relationship  of  the 
various  members  to  each  other. 

Quinin  being  a derivative  of  quinolin,  many  at- 
tempts were  made  to  produce  it  synthetically,  with 
the  resulting  discovery  of  a number  of  quinolin 
derivatives  which  possess  antipyretic  properties. 


i. 

R.  Acetphenetidlni  (phenacetin)  ...  .grs.  xv  1 
Caffein  grs.  viil  5 


Sodli  bromldi  31  4 

Elixir  adjuvant  51  30 


The  mixture  is  to  be  shaken  and  two  teaspoonfuls  given  as 
a dose.  This  is  often  used  for  headache,  one  dose  being 
usually  sufficient. 

Still  another,  widely  used,  mixture  containing  acetanilid,  is 
a migraine  elixir  that  is  being  exploited  by  a number  of 
manufacturers.  A representative  formula,  for  a preparation 
of  this  kind,  may  be  given  as  follows  : 


R.  Acetanilidi  gr.  xxx  21 

Caffeinse  gr.  iii  |2 

Sodii  bromidi  3ii  81 

Alcoholis  31  4 

Elixir  aromatici,  q.  s.  ft Jiii  100 1 


Average  dose  5 c.c.,  or  1 teaspoonful. 

If  20  c.c.  of  tincture  of  cardamon  be  added  to  this,  or 

if  adjuvant  elixir  (which  is  also  official),  be  used  instead 
of  the  aromatic,  the  appearance  of  the  mixture  will  be 
much  enhanced  and  the  psychical  effect  increased. 


250 


PHARMACOPEIA  AXD  PHYSICIAN. 


but  all  of  them  dangerous  because  of  their  ten- 
dency to  produce  collapse.  All  of  these  are  now 
practically  obsolete. 

Another  substance  having  antipyretic  collapse 
action  is  phenylhydrazin,  which  is  of  interest  be- 
cause of  its  derivative,  antipyrin.  Hydrazin  N,H4 
(or  H,N — NH2),  which  is  formed  by  the  union  of 
hydroxylamin  and  ammonia,  usually  exists  in  com- 
bination with  an  organic  radical. 

Starting  with  the  benzene  ring,  C6HG,  or 

H 

C 

X X 

HC  CH 
I I 

HC  CH 
\ x 

C 

H 

benzene 

phenol  (carbolic  acid)  is  formed  by  replacing  an 
H with  OH.  If  this  OH  in  turn  be  displaced  by 
the  hydrazin  radical,  phenyl  hydrazin  is  formed 
thus : 


C[OH  H]HN-NH> 

x x 

HC  CH 
I I + 

HC  CH 

x X 
C 

H 

phenol  + hydrazin  = 


CH3N2+H2O 


HC  CH 

I I 

HC  CH 


X X 
C 

H 

phenyl-hydrazin  + water. 


Though  many  derivatives  of  phenyl-hvdrazin 
have  been  exploited,  antipyrin  and  its  compounds 
are  the  only  ones  in  general  use. 

When  the  practitioner  uses  drugs  which  at  best 
are  so  potent  for  harm  he  will  do  well  to  employ 
them  in  their  simplest  form  rather  than  in  such 
unofficial  combinations  as  hypnal  (chloral  and  an- 


ANALGESICS  AND  SOPORIFICS. 


257 


tipyrin)  or  salipyrin  (salicylic  acid  and  antipy- 
rin) . 

Acetanilid  or  phenyl-acet-amid  is  obtained  by 
the  action  of  boiling  glacial  acetic  acid  on  anilin, 
or  phenyl-amid,  as  it  may  be  termed.  By  intro- 
ducing “acet”  before  “amid”  the  chemic  name  is 
derived. 


CNH[B  HO]OC.CH,  CNH.  OC.CH3  + H20 


HC 

CH 

HC 

CH 

1 

1 + 

— 

1 

1 

HC 

CH 

HC 

CH 

\ 

/ 

\ 

/ 

Phenyl-amid  + acetic  = acetanilid  + water 
(anilin)  acid 

When  other  acid  radicals  replace  that  of  acetic 
acid  similar  compounds  are  formed,  which  are  in 
no  wise  superior  to  the  official.  Thus  we  have  benz- 
anilid  and  exalgin  (or  methyl  acetanilid),  the  lat- 
ter differing  from  acetanilid  only  in  having  a CH3 
group  replacing  an  H. 

It  will  be  understood  from  its  chemistry  why 
acetanilid  can  be  prepared  so  cheaply  and,  there- 
fore, why  it  is  so  extensively  employed  in  the  nos- 
trum traffic. 

Phenetidin  is  important  as  the  basis  of  the  phen- 
acetin  group.  Chemically  it  is  the  ethyl  ether 
(sulphuric,  so  called)  of  amido-phenol.  If  an 
amid  group  (NH„)  replaces  the  H in  the  para 
position  (opposite  to  the  OH)  of  phenol 


COH 

/ \ 

HC  CH 
I I 
HC  CH 

\ / 

C 

H 

Phenol. 


COH 

/ \ 

HC  CH 

CH  CH 

\ / 
c 

nh2 

Para-amido-phenol 


358 


PHARMACOPEIA  AND  PHYSICIAN. 


we  have  para-amido-phenol,  and  if  the  OH  is  then 
replaced  by  ether  we  have  phenetidin.  Various 
acid  radicals  may  replace  an  H of  the  NH2.  If  it 
be  the  acetic  radical  we  have  phenacetin,  if  lactic 
acid  we  have  lactophenin. 

These  formulas  may  appear  complex,  but  a care- 
ful examination  of  them  will  show  the  relationship 
existing  between  the  various  members  of  the  group. 
If  the  practitioner  finds  the  official  phenacetin  un- 
suited to  his  purpose  in  a given  case,  it  is  not 
probable  that  another  compound,  differing  merely 
in  the  nature  of  an  acid  radical,  will  prove  more 
beneficial. 

Among  the  phenetidin  series  there  are,  besides 
the  official  phenacetin,  many  in  which  the  syllable 
“phen”  indicates  the  phenetidin  source.  They  in- 
clude phenocoll,  salophen,  lactophenin  and  many 
others. 

We  shall  have  occasion  to  mention  urethane 
ethyl  carbamate)  among  the  hydrated  chloral 
group,  and  it  may  be  said  that  several  of  its  deriv- 
atives have  been  used  as  antipyretics,  but  they 
do  not  merit  further  consideration  here. 

In  connection  with  the  subject  of  antipyretics 
we  may  mention  a number  of  substances  which, 
except  historically,  are  now  of  little  interest. 
Kairin,  discovered  by  Dr.  0.  Fisher  in  1882,  was 
the  first  of  the  coal-tar  compounds  to  be  introduced 
as  an  antipyretic  on  the  strength  of  physiologic 
experiments.  It  was  also  one  of  the  first  of  the 
medicinal  synthetic  chemicals  to  be  patented.  The 
older  physicians  may  remember  its  widespread 
use  and  some  of  the  exaggerated  claims  that  were 
made  for  it  and  how,  despite  this,  it  fell  into  dis- 
favor and  was  soon  forgotten. 


ANALGESICS  AND  SOPORIFICS.  259 

Thallin,  made  by  Dr.  Skraup  in  1884  and  inves- 
tigated in  the  clinic  of  Nothnagel,  soon  shared  the 
fate  of  kairin,  despite  liberal  advertising. 

Resorcinol. — IT.  S. — Rescorcin  (U.  S.  P. 
1890)  discovered  by  Hlasiwitz  and  Borth  about 
1862,  was  used  as  an  antiseptic  and  later  as  an 
antipyretic,  but  was  found  to  be  too  dangerous  for 
the  latter  purpose.  It  may  be  absorbed  even  after 
external  application,  when  its  effects  resemble 
those  of  phenol  (carbolic  acid). 

The  official  salicylic  acid,  discovered  in  1839, 
was  introduced  as  an  antiseptic  in  1873  and  later 
as  an  antipyretic.  The  salicylates  now  find  their 
greatest  usefulness  in  the  treatment  of  acute  rheu- 
matism. They  will  be  discussed  later. 

THE  HYDRATED  CHLORAL  GROUP. 

The  hydrated  chloral  group  includes,  besides  hy- 
drated chloral,  chloralformamid  (chloralamid), 
paraldehyd,  ethyl  carbonate  (urethane),  sulphon- 
methane  (sulphonal)  and  sulphonethylmethane 
(trional).  Several  of  these  preparations  are  so 
well  known  that  we  may  dismiss  them  in  a few 
words,  but  some  of  them  may  be  profitably  dis- 
cussed at  greater  length. 

It  is  easy  to  drug  anyone  into  unconsciousness, 
but  the  members  of  this  group  do  not  possess  cura- 
tive properties  and  at  most  they  only  secure  rest 
and  sleep  for  the  patient.  Hydrated  chloral  is 
dangerous  and  we  wish  to  point  out  some  of  the 
dangers  attending  its  use,  either  alone  or  in  the 
nostrums  which  contain  it.8 


8.  Attention  has  been  called  to  Bromidia,  which  is  di- 
rected to  be  given  in  as  much  as  teaspoonful  doses  every 
hour  until  sleep  Is  produced,  pain  being  mentioned  as  one 


260 


PHARMACOPEIA  AND  PHYSICIAN. 


All  authorities  agree  that  it  is  unjustifiable  to 
use  large  doses  of  hydrated  chloral,  either  alone  or 
in  combination  with  other  official  drugs.  When  a 
moderate  dose  of  hydrated  chloral  fails  to  induce 
sleep  in  cases  of  severe  pain,  it  is  very  much  more 
rational  to  give  a dose  of  morphin,  or  other  anal- 
gesic, than  to  repeat  the  hydrated  chloral  indefi- 
nitely. The  hydrated  chloral  habit  is  not  rare,  and 
if  its  sale  at  cut  rates  in  the  shape  of  nostrums 
with  fanciful  names  is  to  go  on  unchecked,  we  can 
hardly  hope  to  see  any  diminution  of  the  baneful 
practice.  When  we  employ  hydrated  chloral  and 
sodium,  or  potassium  bromid  in  simple  solution  it 
is  with  full  cognizance  of  the  danger,  but  because 
the  exigencies  of  the  case  demand  their  use,  and  we 
only  use  them  with  caution.* * * * * * 9  In  a general  way  the 
contraindications  for  hydrated  chloral  are  the  same 
as  for  chloroform.  In  the  present  addition  of  the 
Pharmacopeia  it  is  official  as : 

Chlcralum  Hydkatum. — IJ.  S. — Hydrated 

chloral. 


of  the  indications  for  its  use.  Since  hydrated  chloral  is  not 

an  anesthetic,  except  in  unsafe  doses,  it  is  readily  seen  how 

dangerous  this  advice  is,  particularly  when  we  are  dealing 

with  such  intense  pain  as  that  encountered  in  appendicitis, 

even  admitting  that  the  preparation  contains  the  other  in- 

gredients claimed. 

9.  A fairly  safe  and  very  efficient  hypnotic  commonly  used 
in  Bellevue  Hospital  in  New  York  affords  a convenient  form 
of  using  sodium  bromid  with  hydrated  chloral. 

R.  Chloral! grs.  xx  1 30 

Sodii  bromidi grs.  lxxx  5 30 


Syr.  aurantii  cort 3iv  16 

Abus  q.  s.  ad 3i  30 


M.  Two  teaspoonfuls  are  given  at  a dose,  and  this  may 
be  twice  repeated  at  intervals  of  an  hour  if  necessary,  but 
more  than  two  doses  are  rarely  required  in  the  absence  of 
severe  pain. 

The  hydrated  chloral  may  be  slightly  increased  in  the  pre- 
scription, in  which  case  the  dose  should  not  be  repeated  more 
than  once. 


ANALGESICS  AX D SOPORIFICS. 


261 


Average  Dose:  1 gin.  (15  grains). 

Of  the  unofficial,  more  or  less  closely  related 
drugs,  hypnal  (antipyrin  and  hydrated  chloral) 
has  been  mentioned.  Dormiol  is  a combination 
of  amvlene  hydrate  and  hydrated  chloral,  while 
chloralose,  a combination  of  hydrated  chloral  and 
glucose,  partakes  of  the  action  of  morphin  and  is 
rather  expensive.  Chloretone,  a more  recent 
product,  is  not  entirely  devoid  of  danger  and  is  not 
always  so  certain  in  its  action  as  hydrated  chloral, 
while  butyl  chloral  hydrate  or  croton  chloral  hy- 
drate, is  one  of  the  older  compounds  that  has  been 
found  wanting  and  is  now  little  used.  Of  the 
official  compounds  of  this  group  we  have : 

Chloraeformamidum. — U.  S. — Chloralforma- 
mid.  Chloralamid.  This  has  practically  the  same 
action  as  therapeutic  doses  of  hydrated  chloral,  the 
latter  being  formed  in  the  body  by  decomposition 
of  chloralformamid. 

Average  Dose:  1 gm.  (15  grains). 

Paraldehydum. — U.  S. — Paraldehyd,  a trans- 
parent liquid,  is  slower  in  its  action  than  hydrated 
chloral,  but  also  safer.  It  has  the  disadvantage  of 
a persistently  disagreeable  taste  and  odor.  It  is 
locally  irritant  and  should  not  be  used  in  irritable 
conditions  of  the  stomach.  It  may  be  prescribed 
dissolved  in  10  parts  of  water  or  in  aromatic  elixir, 
and  is  best  administered  cold,  or  followed  by  a cold 
drink. 

Average  dose:  2 c.c.  (30  minims). 

SulphonmethajStum. — IT.  S. — Sulphonmeth- 

ane,  sulphonal,  diethylsulphonedimethylmethane, 
and 

SULPHONETHYLMETHANUM. — IT.  S. — Sulphon- 
ethylmethane,  trional,  disulphonmethylethyl- 


2G2 


PHARMACOPEIA  AND  PHYSICIAN. 


methane,  may  be  considered  together  as  they  differ 
chemically  only  in  the  addition  of  an  ethyl  group 
in  the  latter. 

Average  Dose  (either)  : 1 gm.  (15  grains). 

The  therapeutic  action  of  these  two  preparations 
is  practically  identical,  and  the  closely  related 
tetronal  might  also  be  included  in  this  statement. 
Trional  is  somewhat  more  soluble  than  sulphonal. 
While  these  substances  are  safer  than  hydrated 
chloral  they  are  not  wholly  free  from  danger,  as 
fatal  cases  of  poisoning  have  been  reported  and  the 
sulphonal  and  trional  habits,  while  of  more  recent 
origin,  bid  fair  to  equal,  if  not  to  exceed,  the  chlo- 
ral habit  in  the  number  of  their  victims.  These 
agents  are  usually  given  in  powder,  and  owing  to 
their  slow  absorption,  should  be  given  about  two 
hours  before  they  are  expected  to  act.  To  insure 
more  speedy  action  they  may  be  given  in  solution, 
for  which  purpose  they  are  dissolved,  or  at  least 
suspended,  in  a cup  of  hot  milk. 

JEthylis  Carbamas. — U.  S. — Ethyl  Carbam- 
ate, urethane.  This  is  a new  official  preparation 
which  is  claimed  to  be  much  safer  than  hydrated 
chloral,  to  which  it  would  be  distinctly  superior 
but  for  the  fact  that  its  action  is  not  so  certain  and 
because  tolerance  is  soon  acquired.  It  is  best 
given  in  water,  in  which  it  is  very  soluble.  The 
average  dose  is  1 gm.  (15  grains). 

THE  BROMID  GROUP. 

The  bromid  group  is  so  well  known  that  it  re- 
quires little  therapeutic  consideration  here,  but  it 
is  of  considerable  historic,  as  well  as  of  practical, 
interest.  Potassium  bromid  was  introduced  by 
Balard  about  1826.  who  supposed  it  to  have  proper- 


ANALGESICS  AND  SOPORIFICS. 


263 


ties  analogous  to  those  of  potassium  iodid.  It  was 
not  until  some  time  after  1850  that  the  present, 
sedative,  uses  of  the  bromids  were  accidently  dis- 
covered. During  the  past  four  decades  the  sev- 
eral alkaline  bromids  have  received  considerable 
attention  and  several  of  them  are  now  official  in 
every  pharmacopeia.  In  our  own  Pharmacopeia, 
in  addition  to  monobromated  camphor,  hydro- 
bromic  acid  and  the  hydrobromids  of  a number  of 
alkaloids,  we  have  ammonium,  potassium,  lithium, 
calcium,  sodium  and  strontium  bromids  official. 

The  average  dose  of  any  of  these  alkaline 
bromids  is  1 gm.  (15  grains). 

The  abuses  that  have  arisen  in  connection  with 
substances  belonging  to  this  group  are  largely  due 
to  the  misrepresentations  that  are  made  in  connec- 
tion with  the  efficiency  or  the  character  of  the 
nostrums  containing  them. 

Strontium  salts,  particularly  the  bromid,  were 
brought  forward  some  years  since,  at  exorbitant 
prices,  as  being  infinitely  superior  to  the  corre- 
sponding compounds  of  other  elements.  Experi- 
ence has  shown  that,  in  the  main,  these  claims  were 
unfounded,  though  many,  even  now,  claim  that 
strontium  bromid  disturbs  the  stomach  less  than 
the  corresponding  sodium  or  potassium  salt.  An- 
other claim  that  is  frequently  made  by  manufac- 
turers of  nostrums  like  “Peacock’s  Bromides,”  is 
that  they  use  “chemically  pure”  salts.  Exactly 
what  is  meant  by  this  claim  it  is  difficult  to  say,  but 
the  Pharmacopeia  gives  us  a number  of  readily  ap- 
plied tests  by  which  the  salts  themselves  may  be 
tested.  The  manufacturers  of  nostrums,  on  the 
other  hand,  not  infrequently  add  the  very  sub- 
stances that  are  considered  contaminations. 


CHAPTER  XI. 


CIRCULATORY  STIMULANTS. 

The  subject  of  circulatory  changes  is  entirely  too 
extensive  for  anything  like  a comprehensive  treat- 
ment in  the  limited  space  that  can  be  allotted  to 
it  here.  We  shall  endeavor,  however,  to  discuss 
some  of  the  indications  for  influencing  these 
changes  and  try  to  indicate  how  they  may  be 
brought  about. 

The  term  “heart  tonic”  has  been  so  loosely  em- 
ployed that  it  is  better  to  avoid  it  altogether,  or 
to  use  it  only  with  reference  to  those  drugs  which, 
acting  directly  on  the  heart,  improve  the  muscular 
tone. 

The  heart  is  but  one,  and  in  some  respects  even  a 
minor,  factor  in  the  question  of  blood  pressure,  on 
which  the  state  of  the  circulation  largely  depends. 
Hence,  while  a “heart  tonic”  implies  an  agent 
which  improves  the  action  of  the  myocardium,  the 
actual  changes  in  the  circulation  depend  not  alone 
on  the  amount  of  work  done  by  the  central  organ, 
but  on  the  combination  of  that  and  the  constriction 
or  dilatation  of  the  blood  vessels. 

Since  the  relative  amounts  of  blood  existing  in 
the  veins  and  arteries,  and  the  amount  which 
passes  through  a certain  area  or  organ  in  a given 
time  are  dependent  on  several  more  or  less  closely 
related  factors,  we  may  direct  our  efforts  toward 
influencing  one  or  more  of  these  factors  when  we 
wish  to  increase  or  diminish  the  blood  supply  of  an 
organ,  or  when  we  wish  to  hasten  the  transfer  of 
blood  from  veins  to  arteries. 


CIRCULATORY  STIMULANTS. 


265 


An  increase  in  the  rate  of  the  heart  or  strength 
of  the  beat,  without  a compensating  change,  either 
in  the  heart  itself  or  in  the  blood  vessels,  will,  of 
course,  increase  the  general  circulation,  and  con- 
versely, a diminished  action  would  lessen  the  cir- 
culation, but  so  delicately  is  the  complex  circula- 
tory mechanism  adjusted  that  such  a simple 
change  probably  never  occurs  alone  in  the  intact 
body,  though  it  may  at  times  predominate  over 
other  accompanying  changes. 

THE  MECHANISM  OF  STIMULATION. 

The  simplest  means  of  increasing  the  blood  pres- 
sure consists  in  increasing  the  strength  of  the  in- 
dividual beats,  whereby  the  heart  is  more  com- 
pletely and  more  forcibly  emptied,  and  securing 
just  enough  slowing  to  enable  the  heart  to  dilate 
more  fully  and  to  become  filled  with  a larger  vol- 
ume of  blood.  These  two  actions  insure  a larger 
volume  of  blood  being  thrown  into  the  aorta  in  a 
given  length  of  time  than  occurred  under  previous 
conditions.  An  increased  volume  of  blood  with  in- 
creased force,  must,  of  course,  insure  an  increased 
circulation  in  those  areas  in  which  there  is  no 
great  change  in  the  caliber  of  the  smaller  vessels. 

A high  blood  pressure  on  the  other  hand  may 
be  most  simply  reduced  by  slowing  the  heart  with- 
out increasing  its  strength,  or  by  acting  on  the  ves- 
sels peripherally  or  through  the  vasomotor  centers, 
causing  dilation. 

The  accumulation  of  an  undue  amount  of  blood 
in  the  veins  is  relieved  by  increasing  the  efficiency 
of  the  heart  as  mentioned  for  raising  the  blood 
pressure— by  slowing  and  strengthening  its  beat — 
for.  as  we  have  seen,  this  improves  the  drainage 


200 


PHARMACOPEIA  AND  PHYSICIAN. 


from  the  veins  by  lengthening  the  diastole,  while 
the  strengthening  throws  a larger  volume  of  blood 
into  the  arteries. 

We  may  arrange  the  agents  affecting  circulation 
into  two  groups  as  follows : Those  mainly  affect- 

ing the  heart,  directly  or  indirectly;  those  mainly 
affecting  the  vessels,  directly  or  indirectly. 

The  most  important  group  of  circulatory  stim- 
ulants consists  of  digitalis  and  a number  of  sim- 
ilarly  acting  substances.  While,  as  is  well  known, 
barium  chlorid  has  to  some  extent  a similar  action 
to  digitalis,  nearly  all  the  other  members  of  this 
group  that  are  of  therapeutic  importance  are 
somewhat  allied  chemically;  for  the  most  part  the 
active  principles  of  these  drugs  are  glucosids  or 
resins.  The  exact  chemistry  of  the  drugs  of  this 
class  is  still  obscure,  despite  numerous  investiga- 
tions, and  it  demands  but  little  consideration  here ; 
their  pharmacologic  action,  however,  serves  to  ex- 
plain their  therapeutic  indications,  and  may  aid 
in  choosing  the  one  best  suited  to  a given  condi- 
tion. 

The  circulatory  conditions  demanding  stimula- 
tion are  mainly  those  in  which  undue  relaxation  oc- 
curs, and  in  which  an  imperfectly  acting  heart,  in- 
cluding such  conditions  as  valvular  insufficiency 
and  stenosis,  permits  the  blood  to  accumulate  in 
the  veins.  Any  increase  in  the  work  of  the  heart 
must  tend  to  relieve  these  conditions,  particularly 
if  there  is  at  the  same  time  just  sufficient  slowing 
to  secure  complete  distention  of  the  heart  with 
blood  during  diastole. 

An  increase  in  the  strength  of  the  contraction 
more  completely  squeezes  the  venous  blood  out  of 
the  heart  muscle,  which  is  then  supplied  with  a 


CIRCULATORY  STIMULANTS. 


267 


larger  proportion  of  arterial  blood.  The  increased 
force  of  the  pulse  wave  must  first  be  felt  more 
strongly  in  the  coronary  artery  than  elsewhere, 
since  there  is  less  inertia  to  be  overcome  in  the 
much  shorter  column  of  blood  between  the  aortic 
valve  and  the  opening  into  the  coronary  artery. 
The  longer  diastole  then  permits  a more  perfect 
supply  to  the  capillaries  in  the  heart,  thus  improv- 
ing the  nutrition  of  the  heart  to  an  even  greater  de- 
gree than  would  correspond  to  the  extra  work 
thrown  on  the  ventricles  by  their  being  compelled 
to  contract  against  an  increased  arterial  pressure. 

As  we  have  just  said,  the  slowing  of  the  heart 
should  be  just  sufficient  to  enable  the  heart  to  be- 
come fully  distended,  for  a greatly  slowed  heart 
would  suffer  in  lessened  nutrition,  because,  other 
things  being  equal,  the  rate  of  flow  through  the 
coronary  circulation  varies  with  the  number  of  the 
pulsations  in  a given  space  of  time. 

This  improved  nutrition  of  the  myocardium  is 
the  first  essential  for  a sustained  increase  in  the 
force  of  the  beats,  either  from  a more  energetic  ac- 
tion of  the  imaltered  heart  or  after  hypertrophy; 
because,  however,  such  a muscle  might  be  stimu- 
lated to  unusual  activity,  exhaustion  and  paralysis 
must  follow  unless  nutrition  keeps  pace  with  the 
work  performed.  Langendorff  has  shown  experi- 
mentally that  the  energy  of  the  heart  is  enor- 
mously influenced  by  the  available  blood  supply. 
A drug  might  affect  one  or  more  phases  of  the 
heart  beat,  or  the  local  and  central  action  may  be 
in  part  antagonistic  and  the  effect  on  the  blood 
pressure  in  the  general  circulation  will  in  the  lat- 
ter case  be  dependent  on  the  kinds  of  influence 
and  the  degree  to  which  each  is  excited. 

Slight  slowing  with  increased  strength  of  con- 


2C8 


PHARMACOPEIA  AX D PHYSICIAN. 


traction  may  improve  the  nutrition,  and  it  will  be 
readily  understood  why  it  is  difficult  to  secure 
equally  perfect  nutrition  of  the  heart  when  it  is 
made  to  beat  more  rapidly,  since  the  only  factor 
here  which  makes  for  an  improved  coronary  circu- 
lation is  the  more  frequent  squeezing  out  of  venous 
blood  by  the  contractions  while  all  other  conditions 
are  unfavorable,  a greater  number  of  contractions, 
each  throwing  out  less  blood  and  meaning  more 
energy  expended  for  a given  amount  of  work  per- 
formed— a more  frequent  overcoming  of  the  iner- 
tia of  the  blood  in  the  arteries — so  that  a very 
rapid  heart  soon  exhausts  itself.  For  these  reasons 
we  do  not  often  seek  to  raise  blood  pressure  or  to 
improve  the  general  circulation  by  increasing  the 
rate  of  the  heart  unless  it  is  extremely  slow. 

Shock  and  collapse  are  conditions  that  are  due 
to  depression  of  the  respiratory,  cardiac  and  vaso- 
motor centers.  The  depression  of  the  vasomotor 
center  permits  the  vessels  to  dilate  and  the  blood 
gravitates  to  the  vessels  of  the  splanchnic  area, 
which  are  capable  of  holding  a very  large  amount. 
This  dilatation  is  accompanied  by  a fall  of  pres- 
sure in  the  general  circulation,  less  blood  goes  to 
the  centers  and  to  the  coronary  circulation,  the 
heart  beats  more  feebly  and  the  respiration  be- 
comes weaker.  This  condition  obviously  calls  for 
prompt  stimulation  of  the  circulation.  It  is  ap- 
parent, however,  that  a stimulation  of  the  heart 
alone  would  only  result  in  increased  work  while 
its  own  nutrition  would  not  be  correspondingly 
improved  because  the  pressure  in  the  coronary  cir- 
culation can  not  be  greatly  increased  while  the 
voluminous  vessels  of  the  splanchnic  area  offer 


CIRCULATORY  STIMULANTS. 


2G9 


cavernous  spaces  for  the  blood  which  is  pumped 
from  the  heart. 

Stimulation  of  the  constrictor  mechanism  of  the 
vessels  is  urgently  demanded  in  collapse,  and  this 
is  secured  in  the  mildest  cases  by  gravity  determin- 
ing the  blood  to  the  head  when  the  head  is  placed 
lower  than  the  body.  The  centers  are  toned  up  by 
the  better  blood  supply,  and  this  increased  tone  of 
of  the  vasomotor  center  causes  constriction  of  the 
splanchnic  vessels,  raises  the  blood  pressure  and 
improves  the  general  circulation,  which  in  turn 
further  tones  up  the  centers  as  well  as  the  heart, 
which  is  also  stimulated  by  the  improved  tone  of 
the  cardiac  center.  The  respiration  is  improved 
at  the  same  time  owing  to  the  improved  tone  of  the 
respiratory  center. 

Dr.  George  Crile  has  devised  a pneumatic  suit 
whereby  pressure  may  be  applied  to  the  surface  of 
the  limbs,  thus  forcing  a large  amount  of  blood 
into  the  body  and  head,  and  gravity  (lowering  the 
head)  may  be  made  to  assist  in  driving  it  to  the 
head — the  essential  fact  being  to  supply  the 
medulla  oblongata  with  blood. 

PHYSIOLOGIC  SALT  SOLUTION. 

Heat,  mainly  supplied  by  hot  water  bottles, 
should  be  used  with  any  other  measures  in  shock. 
The  amount  of  fluid  in  the  vessels  may  be  consid- 
erably increased  by  injecting,  under  aseptic  pre- 
cautions, into  a vein,  or  even  under  the  skin,  nor- 
mal saline  solution,  or  as  it  is  better  to  term  it, 
physiologic  salt  solution,  made  by  dissolving  9 
grams  of  sodium  chlorid  in  enough  water  to  make 
one  liter,  (approximately  132  grains  of  sodium 
chlorid  to  1 quart  of  water.).  The  solution  should 


270 


PHARMACOPEIA  AND  PHYSICIAN. 


be  boiled  (to  render  it  sterile)  and  then  cooled  to 
about  40°  C.  (104°  F.).  As  noted  above  this 
solution  may  be  used  hypodermically  or  it  may  be 
injected  directly  into  a vein.  Another,  and  at 
times  a very  satisfactory,  method  of  attaining  the 
same  result  is  to  inject  slowly  one  or  two  liters  of 
this  solution  into  the  rectum,  whence  it  is  readily 
absorbed  into  the  circulation. 

Drugs  which  act  on  the  vasomotor  centers  are 
indicated  in  collapse  but  the  simple  means  just 
enumerated  serve,  as  explained,  to  tone  up  the 
centers  in  mild  cases  by  an  improved  blood  sup- 
ply, and  they  are  of  course  preferable  to  mere 
stimulation  by  drugs.  Then,  too,  in  proportion 
to  the  urgency  of  the  case  is  the  difficulty  of  secur- 
ing stimulation  of  the  centers.  In  profound 
shock  the  stimulants  of  the  vasomotor  centers  ap- 
pear to  have  no  lasting  effect,  or  to  increase  the 
trouble.  In  collapse  of  a mild  character,  however, 
a vaso-constrictor  acting  more  powerfully  on  the 
vessels  of  the  splanchnic  area  causes  the  general 
blood  pressure  to  rise,  more  blood  goes  to  the  cen- 
ters, and  they  are  placed  in  a better  tone,  exactly 
as  is  the  case  when  gravity  sends  the  blood  to  the 
head. 

Hot  alcoholic  drinks  are  very  commonly  em- 
ployed in  collapse  and  shock;  they  probably  act 
reflexly  from  the  stomach. 

Some  clinicians  maintain  that  morphin  im- 
proves a weakened  heart.  As  a depressed  center  is 
less  susceptible  to  shock  from  reflex  influences, 
morphin  may  lessen  shock  or  depression  due  to 
pain  and  the  center  will  then  be  able  to  exert  a 
better  influence  on  the  heart.  It  has  often  been 
claimed  that  opium  or  morphin  caused  an  in- 


CIRCULATORY  STIMULANTS. 


271 


creased  supply  of  blood  to  the  brain  by  dilating 
the  vessels  of  that  organ,  and  this  may  account 
for  an  increasd  circulation  in  the  cardiac  center 
and  hence  an  improvement  in  the  heart.  The  de- 
pression of  the  respiratory  center  by  morphin  is 
rather  strong  evidence  against  any  stimulation  of 
the  cardiac  center  however.  Morphin  has  no  direct 
action  on  the  heart  and  its  vasomotor  effects  are 
variable. 

THE  DIGITALIS  GROUP. 

The  pharmacologic  action  of  digitalis  and  that 
of  its  available  active  principles  have  been  more 
extensively  studied  than  has  been  done  in  the  case 
of  any  other  member  of  the  group.  The  isolated 
frog’s  heart,  and  later  the  mammalian,  has  been 
used  to  determine  the  action  on  that  organ  apart 
from  the  influence  through  the  centers.  The  rate 
of  the  isolated  mammalian  heart  is  either  in- 
creased or  little  affected  by  digitalis  or  its  prin- 
ciples, but  Gottlieb  and  Magnus  found  that  the 
strength  of  the  individual  contractions  is  increased 
by  it  and  that  more  actual  work  is  done  by  the 
isolated  heart.  In  the  intact  mammal  digitalis 
slows  the  heart  by  stimulation  of  the  vagus  cen- 
ter, and  the  strength  of  the  beat  is  increased  by 
the  action  on  the  myocardium.  The  vasomotor 
centers  are  stimulated  at  the  same  time.  The 
direct  results  of  these  several  actions  have  been  de- 
tailed in  the  introductory  paragraphs. 

Digitoxin,  the  most  active  of  the  principles  that 
have  been  isolated  from  digitalis,  has  essen- 
tianllv  the  same  action  on  the  circulatory  system  as 
the  drug  itself,  but  being  insoluble  in  water  it  is 
slow  in  producing  its  effects.  Albert  Fraenkel  has 


272 


BHARMACOPEIA  AND  PHYSICIAN. 


found  that  about  sixty  hours  elapsed  after  a single 
effective  dose  was  injected,  hypodermically,  into  a 
cat  before  the  typical  action  was  induced. 

Digitalin,  or  “Digitalinum  verum,”  is  somewhat 
more  soluble  in  water  and  its  action  was  elicited 
in  twenty-four  hours  after  a dose,  corresponding 
in  activity  to  that  of  digitoxin  just  mentioned, 
was  injected  into  a cat,  while  strophanthin  (ob- 
tained from  strophanthus  seeds),  which  is  very 
soluble  in  water,  produced  its  effects  much  more 
rapidly.  The  therapeutic  action  of  these  three  sub- 
stances is  very  similar,  but  Gottlieb  and  Magnus 
found  that  digitoxin  is  capable  of  restoring  an 
irregularly  beating  heart  to  rhythmic  pulsations 
to  an  astonishing  degree ; indeed,  they  were  able  to 
restore  isolated  and  perfused  hearts  to  strong  reg- 
ular beats  after  they  had  gone  into  delirium  cordis. 

Digitalis  and  other  members  of  this  group  have 
the  great  disadvantage  of  causing  cumulative  ef- 
fects when  used  continuously  for  some  time.  Digi- 
toxin produces  these  effects  more  readily  than 
strophanthin  and  digitalin.  Fraenkel  was  able  to 
continue  the  administration  of  digitalin  daily  for 
many  weeks  at  near  the  toxic  dose  without 
cumulative  action.  No  habituation  occurred  in 
this  period,  however,  thus  disproving  the  claims  of 
Heide,  based  on  a much  more  shorter  period  of  ex- 
perimentation, that  such  takes  place. 

Gastric  irritation  is  the  first  evidence  of  a toxic 
action  from  a single  toxic  dose  or  from  cumulative 
action,  and  digitalis,  or  any  of  its  congeners  with- 
out exception,  must  be  stopped  for  a time  when 
cumulative  effects  are  seen.  When  the  heart  is 
slowed  by  any  member  of  the  digitalis  group  the 
action  is  very  persistent. 


CIRCULATORY  STIMULANTS. 


273 


Fraenkel  concludes  that  the  duration  of  the  ac- 
tion on  the  heart  is  proportioned  to  the  stability 
of  the  union  which  takes  place  between  the  drug 
and  the  mechanism  affected,  but  that  the  interval 
elapsing  between  the  time  of  administration  and 
the  beginning  of  the  action  is  proportional  to  the 
insolubility  of  the  principle.  Gottlieb  and  Magnus 
in  experimenting  on  the  isolated  heart  found  that 
digitoxin  caused  a constriction  of  the  coronary 
arteries,  but  that  this  did  not  occur  after  stroph- 
anthin. 

The  following  official  drugs  belong  to  the  digi- 
talis group.  As  noted  before,  there  are  other 
drugs  and  chemicals  that  possess  a somewhat  sim- 
ilar action,  but  it  must  be  evident  to  all  that  noth- 
ing is  to  be  gained,  and  that  much  harm  may  re- 
sult from  giving  heed  to  unwarranted  and  exagger- 
ated claims  of  the  nostrum  maker  who  lauds  a 
preparation  which  ostensibly  depends  on  some 
little  known  drug,  such,  for  instance,  as  the  several 
species  of  cactus. 

By  far  the  most  interesting  as  well  as  the  most 
important  of  the  official  drugs  of  the  group  now 
under  consideration  is: 

Digitalis.1 — U.  S. — This  consists  of  the  dried 


1.  From  what  we  know  of  the  chemistry  of  this  partic- 
ular drug,  and  from  the  action  of  the  known  isolated  proxi- 
mate principles,  it  would  appear  that  in  this  connection  it 
was  particularly  unfortunate  that  the  committee  on  revision 
did  not  see  its  way  clear  to  adhere  more  strictly  to  the  pro- 
posed international  standards  for  the  formulas  of  potent  med- 
icaments and  direct,  for  the  extraction  of  digitalis,  the  pro- 
posed 70  per  cent,  alcohol  in  place  of  the  diluted  alcohol  of 
the  U.  S.  Pharmacopeia.  The  stronger  alcohol  would  have 
had  the  advantage  of  insuring  a more  ready  and  more  com- 
plete solution  of  the  active  principles,  of  answering  better  as 
a preservative  and  of  materially  reducing  the  amount  of 
inert  extractive  now  contained  in  the  official  tincture. 


274 


PHARMACOPEIA  AND  PHYSICIAN. 


leaves  of  Digitalis  purpurea , collected  from  the  sec- 
ond year’s  growth  at  the  commencement  of  flower- 
ing. This  drug  is  official  in  all  pharmacopeias  and 
is  generally  considered  as  being  particularly  sus- 
ceptible to  chemical  change.  It  should  be  care- 
fully preserved  and  should  not  be  kept  for  more 
than  one  year. 

Average  Dose:  0.05  gm.  (1  grain). 

While  the  chemistry  of  digitalis  is  far  -from  be- 
ing thoroughly  understood,  there  are  a number 
of  proximate  principles  derived  from  digitalis  that 
are  now  being  marketed  in  a commercial  way  and 
which  have  well-defined  chemical  as  well  as  physio- 
logic properties;  several  of  them  are  being  ex- 
tensively used  in  this  country  as  well  as  abroad. 
The  most  potent  of  these  unofficial  articles  is : 

Digitoxin : This,  as  has  been  noted  before,  is  sol- 
uble in  alcohol  but  is  nearly  insoluble  in  water. 
The  older  and  in  some  respects  better  known 
French  preparations,  variously  called  digitalin, 
crystallisee,  or  French  digitalin,  closely  resemble 
digitoxin  in  physical  properties  and  also  in  physio- 
logic activity. 

Digitalin  (Digitalinum  verum,  Kiliani)  : This 

is  a white  amorphous  glucosid  that  is  readily  sol- 
uble in  alcohol  but  only  slightly  soluble  in  water. 
While  it  is  less  toxic  than  digitoxin  and  may  be 
given  in  much  larger  doses,  it  closely  resembles 
that  principle  in  its  therapeutic  action  and  uses. 

Digitin  (Merck)  : This  is  also  readily  soluble 

in  alcohol  and  only  slightly  soluble  in  water. 
While  still  available  it  is  now  generally  thought  to 
be  physiologically  inactive  as  a circulatory  stimu- 
lant. 

Digitalein  ( Schmiedeberg)  : This  is  readily 


CIRCULATORY  STIMULANTS. 


275 


soluble  in  water  and  is  probably  a mixture  of  sev- 
eral proximate  principles. 

Digitalin  “German” : This  occurs  as  a yellow- 

ish white,  amorphous  powder  that  is  soluble  in 
both  water  and  alcohol.  It  is  said  to  consist  of  a 
variable  mixture  of  Digitalinum  verum  (Kiliani), 
digitalein  and  digitonin. 

The  following  are  official : 

Extractum  Digitalis. — U.  S. — This  is  made 
from  the  fluidextract  by  evaporation. 

Average  Dose:  0.01  gm.  (10  mg.  or  1/5  grain). 

Fluidextractum  Digitalis. — U.  S. — Fluidex- 
tract of  Digitalis  is  made  with  diluted  alcohol. 

Average  Dose:  0.05  c.c.  (1  minim). 

Infusum  Digitalis. — U.  S. — Infusion  of  Digi- 
talis contains  1.5  per  cent,  of  digitalis,  10  per 
cent,  of  alcohol  and  15  per  cent,  of  cinnamon 
water. 

Average  Dose:  8 c.c.  (2  fluidrams). 

Tixctura  Digitalis.— U.  S. — This  now  repre- 
sents 10  per  cent,  of  the  crude  drug  in  diluted 
alcohol  in  place  of  15  per  cent,  as  formerly  offi- 
cial. 

Average  Dose:  1 c.c.  (15  minims). 

Strophahtiiinum. — U.  S. — This  is  a glucosid, 
or  mixture  of  glueosids,  obtained  from  strophan- 
thus. 

Average  Dose:  0.003  gm.  (0.3  mg.  or  1/200 

grain). 

Strophanthus. — U.  S. — This  consists  of  the 
ripe  seeds  of  Strophanthus  Kombe.  It  is  preferably 
administered  in  the  form  of  the  official  tincture. 

Tinctura  Strophanthi. — IT.  S. — This  prep- 
aration now  represents  10  per  cent,  of  the  drug  in 
65  per  cent,  alcohol,  and  is  double  the  strength  of 


276 


PHARMACOPEIA  AND  PHYSICIAN. 


the  tincture  official  in  the  U.  S.  Pharmacopeia, 
1890. 

Average  Dose:  0.5  c.c.  (8  minims). 

Apocynum. — U.  S. — This  is  the  dried  rhizome 
of  Apocynum  cannabinum,  or  of  other  closely  allied 
species  of  Apocynum.  This  drug  is  said  to  have 
been  used  by  the  American  Indians  in  various  ail- 
ments, and  has  long  been  in  use  as  a household 
remedy.  More  recently  it  has  again  attracted  at- 
tention by  its  possible  uses  as  a circulatory  stimu- 
lant, though  the  practical  results  that  have  been 
attained  so  far  do  not  appear  to  warrant  its  use  in 
all  cases.  The  only  official  preparation  is: 

Fluidextractum  Apocyni. — U.  S. — The 

Fluidextract  of  Apocynum  is  directed  to  be  made 
with  a mixture  of  10  per  cent,  of  glycerin,  60  per 
cent,  of  alcohol  and  30  per  cent,  of  water. 

Average  Dose:  1 c.c.  (15  minims). 

Conv allaria. — TJ.  S. — This  consists  of  the 
dried  rhizome  and  roots  of  Convallaria  majalis. 

Average  Dose:  0.5  gm.  (7y2  grains). 

Fluidextractum  Convallaria. — TJ.  S. — This 
is  made  with  a mixture  of  65  parts  of  alcohol  and 
35  parts  of  water. 

Average  Dose:  0.5  c.c.  (8  minims). 

THERAPEUTIC  ACTIONS  OF  THE  DIGITALIS  GROUP. 

Digitalis  will  he  referred  to  under  the  heading 
of  diuretics  (Chapter  XIII),  for  which  purpose 
the  infusion  is  usually  to  be  preferred. 

As  a circulatory  stimulant  one  of  the  drugs  of 
the  digitalis  group  is  indicated  when  the  heart  is 
weak  and  rapid  and  the  blood  pressure  low,  con- 
ditions which  arise  under  a variety  of  circum- 
stances. 


CIRCULATORY  STIMULANTS. 


Al- 


in cardiac  dilatation  with  weak  systole  digitalis 
affords  an  ideal  remedy  as  may  be  readily  under- 
stood from  the  pharmacologic  action.  In  pneu- 
monia the  right  ventricle  suffers  primarily  and 
digitalis  is  indicated,  for,  while  it  affects  the  right 
ventricle  less  than  the  left,  and  the  auricle  least, 
this  does  not  affect  its  usefulness  in  this  condition, 
because  the  nutrition  of  the  heart — both  left  and 
right — is  supported  by  the  improved  coronary  cir- 
culation, a most  important  factor,  as  we  have  seen, 
when  extra  work  is  thrown  on  the  heart,  and  the 
pulmonary  circulation  is  not  affected  by  the  gen- 
eral vasoconstrictor  action  of  the  digitalis.  In 
this  connection,  the  lengthened  diastole,  while  it 
undoubtedly  affords  a better  chance  for  the  empty- 
ing of  the  pulmonary  veins,  is  a factor  of  but 
minor  importance.  The  use  of  digitalis  in  mitral 
insufficiency  is  familiar  to  all  and  the  pharmaco- 
logic action  readily  explains  its  usefulness  in  this 
connection. 

Digitalis  and  its  congeners  are  said  to  be  harm- 
ful in  some  cases  of  mitral  stenosis,  and  they  may 
fail  to  prove  beneficial  in  insufficiency  of  the  aortic 
valves.  It  is  suggested  that  in  this  condition  the 
blood  may  gravitate  from  the  brain  through  the 
aortic  valve  during  the  lengthened  diastole.  The 
action  of  the  drugs  must  be  carefully  observed  in 
these  conditions  and  they  must  be  withdrawn  if 
they  appear  to  be  doing  harm. 

Drugs  of  the  digitalis  series  are  contraindicated 
in  cases  of  fatty  degeneration  of  the  heart,  since  a 
heart  so  weakened  could  scarcely  support  the  addi- 
tional burden  imposed  by  the  increased  arterial 
tension,  nor  can  hypertrophy  be  expected  to  occur 
in  such  a heart.  They  are  also  contraindicated  in 


278 


PHARMACOPEIA  AND  PHYSICIAN. 


all  conditions  in  which  an  increasing  blood  pres- 
sure would  be  dangerous,  for  instance,  in  aneu- 
rism. 

With  digitoxin  particularly,  one  must  constantly 
watch  for  the  first  symptoms  of  cumulative  action, 
usually  gastric  disturbance,  and  it,  or  other  mem- 
bers of  the  same  group,  should  be  temporarily 
withdrawn  when  suggestive  symptoms  occur. 

The  tincture  of  digitalis  contains  a larger  pro- 
portion of  the  alcohol-soluble  digitoxin  than  does 
the  infusion,  in  which  the  digitoxin  present  is  held 
in  solution  by  means  of  digitonin.  Digitoxin  being 
the  most  irritant  of  the  known  principles  of  digi- 
talis, the  infusion,  containing  digitalin  principally, 
will  often  be  preferred. 

When  the  heart  is  weak  and  irregular  digitoxin 
is  probably  the  most  efficient  remedy  we  possess  for 
restoring  it  to  normal  contraction.  An  alcoholic 
solution  of  digitoxin  may  be  used  to  advantage, 
provided  it  be  well  diluted  with  water  when  ad- 
ministered. It  is  altogether  too  irritant  for  hypo- 
dermic injection,  but  if  the  claim  made  by  Cloetta 
to  the  effect  that  he  has  succeeded  in  preparing  a 
stable,  water-soluble  form  of  digitoxin.  which  is  not 
very  irritant,  is  substantiated,  a distinct  advance 
will  have  been  made  in  digitalis  therapy. 

The  dose  of  digitoxin  as  given  by  the  different 
authors  is  somewhat  variable.  Cushny  states  that 
1/12  mg.  (1/750  grain)  of  crystalline  digitoxin 
may  be°given  three  times  daily.  Schmiedeberg 
recommends  1/5  mg.  (1/330  grain)  of  the  crys- 
talline digitoxin  three  times  daily.  This  is  the 
dose  used  by  Marx  with  good  results  in  Xaunyn’s 
clinic.  The  physician  will  do  well  not  to  exceed 
this  latter  dose  too  greatlv.  bearing  in  mind  that 


CIRCULATORY  STIMULANTS. 


279 


cumulative  effects  may.  and  sometimes  do,  develop 
quite  suddenly,  even  with  a dose  which  has  been 
apparently  harmless. 

Digitoxin  and  digitalin,  pure  or  in  the  leaf,  are 
changed  into  substances  with  a convulsive  action 
in  the  presence  of  moisture,  by  bacteriologic  ac- 
tion, hence  old  infusions  should  not  be  used  nor 
should  such  leaves  be  employed  which  bear  evi- 
dences of  not  having  been  properly  dried  and  care- 
fully preserved. 

Digitoxin  and  digitalin  may  be  kept  dissolved 
in  alcohol  and  diluted  as  required.  The  dose  of 
digitalin,  or  digitalinum  verum,  is  from  2 to  6 mg. 
(1/30  to  1/10  grain)  three  times  daily. 

Digitoxin  may  be  prescribed  as  follows : 

JDigitoxini  (cryst.)  gr.  1/12  [005 

Alcoholis  q.  s.  ad 3iii  100 1 

M.  Ft.  solutio.  Sig. : One  teaspoonful  in  a little 

water  three  times  a day. 

Digitalin  can  be  prescribed  in  the  same  way  but 
0.05  is  used  in  place  of  0.005  gm.  thus : 

Digitalini  veri  gr.  i 1 05 

Alcoholis  q.  s.  ad 3iii  100] 

M.  Ft.  solutio.  Sig. : One  teaspoonful  in  water 

three  times1  daily. 

The  tincture  of  digitalis,  diluted  with  water, 
is  given  alone  three  times  a day.  Owing  to  the 
slow  excretion  it  is  not  necessary  to  repeat  the  dose 
more  frequently,  and  the  drug  should  be  stopped 
for  two  days  about  once  a week  to  avoid  cumu- 
lative effects,  whether  one  of  the  active  principles 
or  a Galenic  preparation  of  digitalis  is  being  used. 

Sollmann  has  suggested  that  strophanthin  may 
deserve  an  even  greater  popularity  than  digitalis, 
and  this  suggestion  has  found  support  in  more  re- 
cent investigations.  Strophanthin  is  now  official. 


280 


PHARMACOPEIA  AND  PHYSICIAN. 


whereas  the  active  principles  of  digitalis  have  not 
as  yet  been  included  in  our  Pharmacopeia. 

Strophanthin  causes  but  little  vasoconstriction 
and  it  therefore  deserves  the  preference  over  digi- 
talis and  its  principles  when  increased  blood  pres- 
sure is  to  be  avoided.  Thus,  when  dilatation  of 
the  heart  is  due  to  high  blood  pressure  from  in- 
creased arterial  tension,  strophanthin  may  be 
used,  or  if  digitalis  is  employed,  a vasodilator  such 
as  nitroglycerin  or  one  of  the  nitrites  should  be 
given  at  the  same  time. 

Because  of  its  more  prompt  effect  on  the  heart, 
strophanthin  may  be  employed  to  usher  in  the 
action  when  digitalis  is  to  be  employed.  This 
promptness  of  action  would  also  render  it  prefer- 
able to  digitalis  in  shock  or  collapse  were  it  not 
that  the  vasoconstrictor  action  is  wanting. 

Digitalis,  or  one  of  its  principles,  may  be  given 
several  hours  before  an  operation  when  there  is 
reason  to  apprehend  shock,  so  that  its  action  may 
coincide  with  the  time  that  shock  occurs  instead  of 
waiting  till  that  condition  has  actually  developed 
before  giving  the  slowly  acting  remedy. 

Strophanthus  seed  and  the  tincture  were  for- 
merly of  very  variable  quality,  but  at  the  present 
time  they  are  fairly  uniform. 

Strophanthin.  the  active  principle  of  strophan- 
thus seed,  is  of  constant  composition,  is  very  solu- 
ble in  water  and  may,  therefore,  be  dispensed  in 
simple  solution.  However,  it  undergoes  decompo- 
sition, in  aqueous  solutions,  and  it  is,  therefore, 
better  to  prescribe  it  in  diluted  alcohol : 0.01  gm. 
(1/5  grain)  may  be  directed  to  be  dissolved  in 
150  c.c.  (5  fluidounces)  of  diluted  alcohol  and  one 


CIR C ULA TORY  8 TI M l LA N TS. 


281 


teaspoonful  of  this  solution,  diluted  with  water, 
given  three  times  a day. 

Dr.  H.  C.  Wood,  Jr.,  recommends  Canadian 
hemp  as  a satisfactory  and  reliable  circulatory 
stimulant,  but  as  his  published  work  appears  to 
have  been  done  with  a fluidextract  of  Apocynum 
cannabinum  and  as  the  Pharmacopeia  itself  recog- 
nizes closely  allied  species  of  apocynum,  that  may 
or  may  not  have  similar  physiologic  properties  and 
therapeutic  uses,  it  may  be  well  to  await  the  re- 
sults of  further  investigations  before  trusting  too 
duplicity  in  the  possible  results  to  be  obtained  from 
this  drug. 

Other  official  members  of  this  group  have  little 
to  recommend  them  in  preference  to  the  more 
prominent  ones  just  described. 

It  might  be  added  that  the  alkaloid  of  the  supra- 
renal gland  is  not  suited  for  long  continued  admin- 
istration. It  does  not  influence  blood  pressure 
when  given  by  the  stomach,  and  but  slightly  or 
not  at  all  when  injected  just  beneath  the  skin. 
When  injected  into  the  muscle  there  is  a transient 
rise  of  blood  pressure.  Its  local  use  has  been  dis- 
cussed at  greater  length  in  connection  with  as- 
tringents (Chapter  AC). 

STRYCHNIN. 

Strychnin,  unlike  digitalis,  has  no  preceptible 
direct  action  on  the  heart,  but  produces  its  circu- 
latory effects  wholly  by  its  influence  on  the  centers, 
except  in  so  far  as  the  local  action  on  the  alimen- 
tary canal  is  concerned ; this  may  be  disregarded  in 
the  present  consideration  of  strychnin,  which  is 
commonly  injected  hypodermically  when  its  eir- 
culatorv  effects  are  desired. 


282 


PHARMACOPEIA  AXD  PHY  SIC  I AX. 


Therapeutic  doses  of  strychnin  cause  a rise  of 
blood  pressure  by  stimulation  of  the  vasomotor 
center ; the  reflexes  are  increased,  leading  to  im- 
proved tone  of  the  voluntary  muscles,  and  in- 
creased muscular  activity  always  tends  to  increase 
the  heart  rate;  this  tendency,  however,  is  counter- 
acted by  the  stimulation  of  the  vagus  center  by 
strychnin,  the  heart  being  slowed  or  showing  little 
change  in  frequency.  When  the  slowing  is  exces- 
sive there  is  a fall  of  blood  pressure  despite  the 
vasoconstriction,  but  this  does  not  usually  occur. 
If  the  tendency  to  increased  frequency  predomin- 
ates over  the  vagus  stimulation  the  rise  of  blood 
pressure  is  further  augmented. 

As  strychnin  operates  readily  to  produce  its  ef- 
fects it  is  a most  valuable  remedy  when  a quick 
rise  of  blood  pressure  is  required.  So  rapidly  are 
its  effects  elicited  that  convulsions  may  occur  in  a 
frog  within  two  minutes  of  the  injection  of  a toxic 
dose,  and  after  massive  doses  rabbits  may  give  a 
single  convulsive  leap  into  the  air  and  be  appar- 
ently lifeless  from  paralysis  of  the  respiratory  and 
other  centers  when  they  strike  the  operating  table. 

Biberfeld  has  investigated  its  mode  of  action 
on  the  respiratory  center.  He  depressed  the  res- 
piration by  morphin.  after  which  strychnin  was 
injected;  this  usually  resulted  in  a greater  in- 
crease in  volume,  (sometimes  even  exceeding  that 
before  the  administration  of  morphin).  than  in 
frequency. 

It  has  been  suggested  that  morphin  depressed 
the  reflex  excitability,  while  strychnin  tends  to 
make  all  reflex  efforts  maximum. 

Biberfeld  agrees  with  previous  investigators  that 


CIRCULATORY  STIMULANTS. 


283 


strychnin  does  not  cause  increased  irritability  of 
the  center  for  sensory  impulses  coming  from  the 
lungs,  but  considers  the  chemic  stimulation  of  the 
blood  the  essential  factor.2 

The  following  preparations  are  official : 

Steychnina. — IT.  S. — :This  is  an  alkaloid  ob- 
tained from  nux  vomica;  it  is  also  obtainable 
from  other  plants  of  the  Loganiaeece. 

Strychnin  is  only  slightly  soluble  in  water 
1/6400,  but  is  soluble  in  110  parts  of  alcohol. 

Strychnin.®  Sulphas. — IT.  S. — This  is  the 
salt  of  strychnin  that  is  most  extensively  used  in 
this  country  ; it  contains  five  molecules  of  water 
and  approximately  78  per  cent,  of  strychnin  alka- 
loid. Strychnin  sulphate  is  soluble  in  31  parts 
of  water  and  in  65  parts  of  alcohol. 

2.  Owing  to  the  frequency  with  which  poisoning  by  strych- 
nin occurs,  its  toxicology  deserves  brief  mention  here. 

As  is  well  known,  strychnin  causes  a characteristic  type 
of  convulsion  rather  closely  resembling  tetanus.  The  amount 
of  the  alkaloid  that  is  necessary  to  produce  this  toxic  effect 
is  much  greater,  however,  than  is  usually  supposed  ; but,  on 
the  other  hand,  when  once  a large  amount  has  actually  en- 
tered the  circulation,  there  is  little  hope  of  ultimate  recovery. 
As  death  is  due  to  paralysis  of  the'  respiratory  center  life 
may  be  prolonged,  and  a possible  recovery  brought  about,  by 
carrying  on  artificial  respiration.  This,  however,  should  be 
begun  before  natural  respiration  ceases  or  even  before'  it  be- 
comes very  greatly  depressed. 

Strychnin  requires  several  days  (3  to  8)  for  its  total  elimi- 
nation. Diuretics  hasten  elimination  and  may  be  of  benefit 
when  the  amount  of  the  poison  that  has  been  taken  does  not 
greatly  exceed  the  minimum  fatal  dose. 

Cushny  advises  strong  tea  (infusion)  when  the  patient  is 
seen  with  the  strychnin  in  the  stomach.  This  advice  seems 
to  be  based  on  a misconception  of  the  capacity  of  tea  tannin 
for  forming  the  insoluble  tannate. 

The  fact  that  strychnin  acts  directly  by  paralyzing  the  re- 
spiratory center  fully  explains  the  possible  danger  that  may 
result  from  the  use  of  a stomach  tube,  and  it  will  not  be  nec- 
essary to  repeat  this  frequent  caution. 


284 


PHARMACOPEIA  AND  PHYSICIAN. 


On  the  continent  of  Europe  the  preference  is 
Usually  accorded  to  the  nitrate.  This  is  official  in 
our  Pharmacopeia  as : 

Strychnine  Nitras. — U.  S. — This  represents 
84  per  cent,  of  strychnin  alkaloid  and  is  soluble 
in '42  parts  of  water  or  in  120  parts  of  alcohol. 

The  average  dose  of  either  of  the  official  prep- 
arations is  given  as  0.001  gm.  (1  mg.  or  1/64  gr.). 

Strychnin  is  useful  in  all  forms  of  low  blood 
pressure  because  of  its  action  on  the  vasomotor 
center. 

There  can  be  little  doubt  of  the  beneficial  ef- 
fects of  strychnin  in  many  cases  of  shock  or  col- 
lapse, but  when  irrecoverable  shock  exists  it  ap- 
pears to  depress  further  the  centers  after  an  ex- 
tremely brief  stimulation.3 

To  secure  its  greatest  usefulness  in  conditions  of 
this  kind  strychnin  should  be  given  hypodermic- 
ally, or  to  secure  an  even  quicker  action  it  should 
be  injected  deeply  into  the  muscle  of  the  arm  or 
thigh.  This  method  of  hypodermic  injection  is 
usually  to  be  preferred  as  it  is  le-s  painful  than  in- 
jections just  beneath  the  skin. 

Strychnin  is  one  of  the  best  respiratory  stimu- 
lants and  in  an  emergency  large  doses  may  be 
given.  It  is  always  to  be  remembered  that  strych- 
nin is  a remedy  for  the  crisis  and  is  not  to  be 

3.  Crile  defines  surgical  shock  as  an  exhaustion  of  the 
vasomotor  centers,  the  cardiac  and  respiratory  centers  being 
only  secondarily  involved,  and  collapse  as  due  to  a suspen- 
sion of  the  functions  of  the  cardiac  or  vasomotor  centers  or 
to  hemorrhage.  Of  course,  an  exhausted  or  paralyzed 
structure  can  not  be  stimulated.  Sollmann  defines  both  shock 
and  collapse  as  a sudden  depression  of  the  activity  of  the 
medullary  center  ; if  of  reflex  origin,  shock  : if  direct,  collapse. 
We  employ  the  terms  in  the  latter  sense.  A depressed  center 
may  be  stimulated. 


CIRCULATORY  STIMULANTS. 


285 


used  as  digitalis  is,  to  maintain  blood  pressure  for 
a considerable  length  of  time. 

When  paralysis  of  the  limbs  is  due  to  a lesion 
in  the  cord  which  completely  blocks  the  transmis- 
sion of  nerve  impulses  strychnin  can  do  no  good, 
since  it  has  no  peripheral  action,  but  if  the  paraly- 
sis results  from  a lesion  in  the  brain  the  increased 
reflexes  which  strychnin  causes  will  serve  to  delay 
muscular  atrophy.  It  may  also  serve  to  restore  the 
tone  of  the  reflexes  when  these  are  lowered  by 
functional  disturbances  of  the  cord.  Thus  incon- 
tinence of  feces  and  urine  may  be  relieved  when 
these  are  due  to  the  lowered  reflex  centers  for  the 
sphincters  of  the  bladder  and  anus. 

Caffein  is  closely  related  to  staychnin,  to  which, 
however,  it  is  greatly  inferior,  so  far  as  any  in- 
fluence on  the  circulation  is  concerned.  It  stimu- 
lates the  vasomotor  and  respiratory  centers  and  is 
useful,  therefore,  in  the  treatment  of  poisoning  by 
morphin  and  other  narcotics,  in  the  form  of  strong 
tea,  but  strychnin  serves  the  same  purpose  and 
more  efficiently. 

Hoffmann  noticed  that  theobromin  possessed  a 
stimulant  action  on  the  myocardium,  similar  to 
that  shown  by  caffein,  but  no  vasoconstrictor  effect. 
In  therapeutic  doses  of  either  agent,  however,  this 
cardiac  effect  is  of  little  importance. 

ATROPIN. 

Atropin  causes  acceleration  of  the  heart  by  par- 
alyzing the  vagus  endings,  and  this  also  causes  an 
increased  systole  and  a lessened  diastole.  The 
rate  of  the  heart  may  be  twice  as  great  as  under 
normal  conditions,  the  result  being  a considerable 


•280  PHARMACOPEIA  AND  PHYSICIAN. 

increase  in  the  output  of  the  heart  in  a unit  of 
time. 

The  effect  on  the  circulation  of  the  increased 
heart  action  is  supplemented  by  the  constriction 
of  the  arterioles  of  the  splanchnic  area,  due  to 
stimulation  of  the  vasoconstrictor  center  by  atro- 
pin, which  also  stimulates  the  vasodilator  center 
for  the  vessels  of  the  skin,  particularly  those  of  the 
face  and  neck,  but  this  is  of  comparative^  little 
influence  on  the  general  blood  pressure  which 
rises  in  response  to  the  two  actions  just  mentioned. 

The  influence  of  atropin  on  the  heart  rate  is 
much  less  in  children  and  in  old  age  than  it  is  be- 
tween the  ages  of  20  and  60  years,  because  the 
vagus  inhibition  is  slight  at  the  extremes  of  life 
in  man.  The  vagus  is  much  more  active  in  some 
animals  than  in  others.  In  this  respect  the  dog  re- 
sembles man. 

Atropin  majf  cause  a brief  but  unimportant 
slowing  of  the  heart,  due  to  stimulation  of  the  cen- 
ter. preceding  the  acceleration  which  depends  on 
the  paralysis  of  the  vagus  endings.  While  it  has 
been  undeniably  shown  that  atropin  may  power- 
fully stimulate  the  myocardium,  this  effect  with 
therapeutic  doses  is  so  slight  that  it  may  be  en- 
tirely disregarded.  Atropin  acts  as  a stimulant  to 
the  respiratory  center,  but  it  is  inferior  in  this  re- 
>pect  to  strychnin ; it  increases  the  rate,  and  prob- 
ably the  depth,  of  the  respiration. 

The  central  action  of  atropin  is  exerted  mainly 
on  the  motor  area,  but  it  has  been  suggested  that 
the  differences  between  the  action  of  atropin, 
caffein  and  strychnin  on  the  various  parts  of  the 
central  nervous  system  are  in  degree  rather  than  in 
kind.  Thus,  while  caffein  acts  mainly  on  the 


CIRCULATORY  STIMULANTS. 


287 


higher  centers  in  man,  stimulating  the  psychic 
functions,  it  is  capable  of  causing  strychnin-like 
convulsions  in  the  frog.  All  three  act  as  powerful 
respiratory  stimulants  in  mammals. 

Atropin  is  official  as : 

Atropina. — U.  S. — Atropin  is  an  alkaloid  pre- 
pared from  Air  o pa  Belladonna , or  from  other 
plants  of  the  same  family.  It  is  soluble  in  450 
parts  of  water  and  in  less  than  2 parts  of  alcohol. 

Atropine  Sulphas. — U.  S. — This  salt  of  atro- 
pin is  official  in  many  if  not  all  pharmacopeias 
and  is  the  best  known  and  most  widely  used  prep- 
aration of  the  atropin  group.  It  is  soluble  in  less 
than  one  part  of  water  and  in  4 parts  of  alcohol. 

Average  Dose:  (Alkaloid  or  salt)  0.0004  gm. 

(0.4  or  1/160  gr.). 

Atropin  is  indicated  when  the  heart  is  consider- 
ably slowed.  For  this  purpose  the  average  dose 
given  above  is  not  usually  sufficient,  about  1 mg. 
(1/65  grain)  being  necessary  to  increase  the  rate; 
so  large  a dose  being  necessary  to  produce  paralysis 
of  the  vagus  endings  in  the  heart.  If  must  be 
remembered,  however,  that  in  children  and  in  the 
very  old  (after  70)  the  effect  to  be  expected  is 
much  less  than  that  seen  between  the  ages  of  20 
and  60.  This  larger  dose  causes  stoppage,  or,  at 
least,  a marked  diminution  of  salivary  secretion 
with  consequent  dryness  of  the  mouth  and  throat. 

While  atropin  has  been  used  in  shock  and  col- 
lapse, it  can  have  but  little  influence  on  blood  pres- 
sure or  respiration  in  such  cases.  Atropin  may  be 
used  to  determine  Avhether  an  abnormally  slowed  or 
intermittent  heart  results  from  central  influences 
or  from  causes  within  the  heart  itself,  since  it  cuts 
off  all  impulses  from  the  center  arriving  through 


288 


PHARMACOPEIA  AND  PHYSICIAN. 


the  vagus,  but  produces  no  appreciable  effect  if  the 
cause  lies  within  the  heart. 

Atropin  has  been  used  to  prevent  the  reflex  stop- 
page of  the  heart  occurring  at  the  commencement 
of  anesthesia,  but  it  has  been  shown  that  there  is 
no  danger  of  such  a catastrophe  if  the  anesthetic 
is  not  used  in  too  great  concentration. 

Poisoning  by  certain  fungi  which  contain  mus- 
carin,  while  rare,  may  best  be  treated  with  moder- 
ate doses  of  atropin.  Pilocarpin  is  also  antag- 
onized in  nearly  all  its  actions  by  atropin,  but  the 
latter  does  not  counteract  the  cardiac  effects  of 
phvsostigmin  which  acts  on  the  myocardium. 

The  value  of  atropin  in  opium  poisoning  has 
been  much  disputed.  It  seems  to  possess  no  ad- 
vantage over  caffein  and  strychnin  in  such  cases 
and  it  has  the  disadvantage  of  adding  to  the  de- 
pression of  the  respiratory  center  if  more  than  a 
small  dose  is  given.  Clinical  experience  seems  to 
have  abundantly  proved  that  small  doses  of  atro- 
pin are  corrective  for  ordinary  doses  of  morphin, 
and  it  is  almost  universally  so  used.4 

Atropin  is  usually  given  hypodermically  when 
the  central  effects  are  desired. 

CAMPHOK. 

Camphora. — U.  S. — Camphor  is  a white,  vola- 
tile, solid  substance  having  a crystalline  structure 
and  a characteristic  aromatic  odor  and  taste.  Cam- 
phor has  been  used  in  the  Far  East  for  many  cen- 
turies, but  was  not  known  in  Europe  until  intro- 

4.  A widely  used  combination  consists  of  morphin  sul- 
phate 0.015-  gm.  (J4  grain)  and  atropin  sulphate  0.0004  gm. 

(1/160  grain)  prepared  in  the  form  of  the  now  popular  hy- 
podermic tablets  or  dissolved  in  distilled  water  sufficient  for 
one  dose. 


CIRCULATORY  STIMULANTS. 


289 


duced  by  the  Arabians.  It  is  now  official  in  all 
pharmacopeias. 

Average  Dose:  0.12  gm.  (2  grains). 

Aqua  Camphors. — TJ.  S. — This  is  a saturated 
solution  of  camphor  in  distilled  water.  It  is  fre- 
quently used  as  a vehicle  for  other  medical  sub- 
stances. 

Average  Dose:  1 c.c.  (2  fluidrams). 

Spiritus  Camphors. — U.  S. — This  is  a 10  per 
cent,  solution  of  camphor  in  alcohol. 

Average  Dose:  1 c.c.  (15  minims). 

Linimentum  Camphors. — U.  S. — This  prep- 
aration, variously  known  as  camphor  liniment  and 
camphorated  oil,  contains  20  per  cent,  of  camphor 
dissolved  in  cottonseed  oil.  While  largely  used  as 
a mildly  rubefacient  local  application  it  is  not  in- 
frequently used  for  hypodermic  injections  or  for 
the  internal  administration  of  camphor  in  the 
form  of  an  emulsion.  The  average  dose  would  be 
about  half  of  that  given  under  spirit  of  camphor. 

In  shock  or  collapse  camphor  is  given  by  the 
stomach,  producing  a feeling  of  warmth  and  prob- 
ably acting  reflexly  for  the  most  part.  The  respir- 
atory and  vasomotor  centers,  as  well  as  the  heart 
muscle,  are  stimulated,  thus  causing  a rise  of 
blood  pressure.  The  heart  is  usually  slowed  and 
the  contraction  strengthened.  Camphor  is  almost 
insoluble  in  water  and  only  slightly  volatile  at  the 
body  temperature,  and  its  action,  therefore,  is  very 
uncertain;  0.03  gm.  (!4  grain)  may  improve  the 
pulse  in  some  cases  while  twenty  times  as  much 
may  he  required  in  others,  hence  but  little  reliance 
can  be  placed  on  it  in  crises,  though  it  is  very  often 
effective.  The  spirit,  diluted  with  water,  is  fre- 
quentlv  used  for  internal  administration.  A num- 


290 


PHARMACOPEIA  A XL)  PHYSICIAA. 


ber  of  camphor  derivatives  have  been  employed 
from  time  to  time,  but  they  have  not  been  shown  to 
possess  any  advantages  over  camphor  itself,  or  one 
of  its  more  simple  preparations. 

Camphor  is  frequently  employed  as  a diapho- 
retic, particularly  in  combination  with  other 
agents,  because  of  its  stimulation  of  the  vasodila- 
tor centers  for  the  cutaneous  vessels. 

As  noted  above,  camphor  water  alone  has  little 
therapeutic  value  and  is  useful  mainly  as  a vehicle 
for  other  substances.  Camphor  may  be  given  in 
pill  form,  in  capsules  or  in  the  form  of  an  emul- 
sion. Probably  the  best  method  of  administering 
camphor  consists  in  suspending  the  finely  pow- 
dered substance  in  twenty  parts  or  more  of  milk. 
For  this  purpose  from  twenty  drops  to  one  tea- 
spoonful of  the  spirit  of  camphor  may  be  directed 
to  be  given  in  one  or  two  tablespoonfuls  of  milk. 

The  several  preparations  of  camphor  are  com- 
monly employed  externally  as  a mild  rubefacient, 
but  the  action  of  camphor  when  applied  in  this 
way  is  largely,  if  not  entirely,  a local  one. 

MUSK. 

Moschus. — U.  S. — This  substance  has  been 
used  in  Europe  for  several  centuries,  and  in  China 
and  other  far  Eastern  countries  from  time  im- 
memorial. The  poi’tion  that  is  now  official  is  de- 
scribed a?  •'‘The  secretion  from  the  preputial  fol- 
licles of  ]\[oschus  moschiferus”  (musk  deer),  an 
animal  which  inhabits  Thibet  and  other  parts  of 
Central  Asia. 

Average  Dose:  0.25  gm.  (4  grains). 

Tinctura  Moschi. — IT.  S. — This  represents  5 
per  cent,  of  musk  in  diluted  alcohol. 


CIRCULATORY  STIM ULANTS. 


291 


Average  Dose:  1 c.c.  (15  minims). 

Musk  was  brought  forward  nearly  a century  ago 
as  a powerful  circulatory  stimulant,  and  S.  Solis- 
Cohen  recently  recommended  it  as  an  efficient  and 
dependable  remedy  when  it  can  be  obtained  of 
good  quality,  but  it  is  extremely  expensive  and 
subject  to  gross  adulteration. 

Musk  probably  resembles  camphor  in  its  action 
on  the  centers  and  has  the  advantage  of  greater 
solubility  in  proportion  to  the  amount  required. 

Castor  fiber  and  sumbul  root,  which  have  been 
recommended  as  substitutes  for  musk,  are  entirely 
devoid  of  any  such  central  action  as  that  claimed 
for  the  latter. 

Musk  may  be  given  in  capsules,  or  in  some  cases 
the  tincture  may  be  preferred. 

AMMONIUM  PREPARATIONS. 

While  ammonia,  as  one  of  the  products  of  the 
decomposition  of  nitrogenous  materials,  was  known 
from  a very  early  period,  the  volatile  salts  of  this 
substance  were  not  available  in  Europe  as  medi- 
cines until  after  the  thirteenth  century,  when  Ray- 
mundus  Lulius  first  produced  ammonium  carbon- 
ate from  urine.  The  stimulating  action  of  this 
salt,  it  is  said,  was  known  for  many  centuries  to 
the  Hindoos,  and  was  probably  known  to  the 
Arabians.  It  is  now  official  as: 

Ammonii  Carbonas.— U.  S.— This  is  a white, 
hard,  translucent  solid  having  the  characteristic 
odor  of  ammonia  and  a sharp  saline  taste.  The 
official  salt  is  described  as  being  “a  mixture  of 
acid  ammonium  carbonate  and  ammonium  car- 
bamate.” 

Average  Dose:  0.25  gm.  (4  grains). 

Aqua  Ammoni.e. — IT.  S. — This  is  an  aqueous 


292 


PHARMACOPEIA  AMD  PHYSICIAX. 


solution  of  ammonia  containing  10  per  cent.,  by 
weight,  of  gaseous  ammonia. 

Average  Dose:  1 c.c.  (15  minims). 

Spikitus  Ammonite  Aromaticus. — U.  S. — 
This  is  a hydroalcoholic  solution  containing  3.4 
per  cent,  of  ammonium  carbonate,  9 per  cent,  of 
ammonia  water  and  70  per  cent,  of  alcohol  aroma- 
tized with  oil  of  lemon,  oil  of  lavender  flowers, 
and  oil  of  nutmeg. 

Average  Dose:  2 c.c.  (30  minims). 

The  volatile  salts  of  ammonium,  in  the  form 
of  the  well-known  “smelling  salts,”  are  very  com- 
monly employed  by  inhalation  for  their  reflex  ef- 
fects on  the  respiratory  and  cardiac  centers.  The 
aromatic  spirit  of  ammonia  when  taken  by  the 
stomach  has  a similar  action.  Other  actions  of  am- 
monium salts  have  been  enumerated  in  previous 
chapters. 

The  water  of  ammonia,  when  taken  internally, 
merely  acts  as  a caustic  alkali.  It  is  seldom  so 
used.  The  aromatic  spirit  is  usually  added  to 
water  at  the  moment  of  taking. 

Smelling  salts  consist  of  varying  mixtures  of 
ammonium  carbonate,  or  of  ammonium  chlorid 
with  potassium  carbonate,  and  spirit  of  ammonia, 
to  which  oil  of  lavender  flowers  is  usually  added 
as  an  aromatic. 

ALCOHOL  AND  DERIVATIVES. 

Alcohol,  or  distilled  spirit,  was  probably  intro- 
duced into  Europe  by  the  Arabians  in  the  10th  or 
11th  century.5  Apart  from  the  several  forms  of 
alcohol  that  are  official  we  have : 

5.  According  to  Pereira  the  Arabians  obtained  their  knowl- 
edge of  distilled  spirit  from  the  Chinese,  who  knew  and 
used  distilled  spirit  at  a much  earlier  period. 


CIRCULATORY  STIMULANTS. 


293 


Spiritus  Frumenti. — LT.  S.- — An  alcoholic 
liquid  obtained  by  the  distillation  of  the  mash  of 
fermented  grain,  such  as  Indian  corn,  rye,  wheat 
and  barley,  or  their  mixtures.  To  conform  with 
the  official  requirements  whisky  should  be  at  least 
four  years  old  and  comply  with  a number  of  phy- 
sical requirements  and  chemical  tests  that  are  now 
provided. 

Spiritus  Vint  Gallici. — U.  S. — Brandy.  This 
is  an  alcoholic  liquid  obtained  by  the  distillation 
of  the  fermented  unmodified  juice  of  fresh  grapes. 
Like  whisky  it  should  be  at  least  four  years  old 
and  should  conform  to  the  tests  for  identity  and 
purity  that  are  described  in  the  Pharmacopeia. 

iP.TiiER.- — TJ.  S. — Ether  or  ethyl  oxid  was  dis- 
covered by  Valerius  Corclus,  about  1540,  and  de- 
scribed as  “Oleum  vitrioli  dulci.”  The  prepara- 
tion appears  to  have  been  entirely  forgotten  and 
was  rediscovered  by  Frobenius,  a London  apoth- 
ecary, about  1730. 

Sulphuric  ether,  the  name  given  it  at  that  time,, 
although  long  known  to  be  a misnomer,  is  still  re- 
tained in  connection  with  commercial  varieties  of 
the  substance. 

Average  Dose:  1 c.c.  (15  minims). 

Spiritus  aEtheris. — U.  S. — This  contains  32.5 
parts  of  ether  and  67.5  parts  of  alcohol. 

Average  Dose:  4 c.c.  (1  fluidram). 

Spiritus  JEtheris  Compositus. — U.  S. — This 
preparation,  more  popularly  known  as  Hoffmann’s 
anodyne,  contains  2.5  per  cent,  of  ethereal  oil,  in 
addition  to  the  ether.  It  has  no  evident  advantages 
over  the  simple  spirit  of  ether  and  may  be  given 
in  the  same  dose. 

Alcohol  in  the  form  of  whisky  or  brandy  is 


294 


PHARMACOPEIA  AND  PHYSIC  I AX. 


much  used  in  shock  or  collapse  in  connection  with 
other  agents  such  as  strychnin  and  digitalis.  Its 
value  is  strongly  asserted  by  some  authorities  and 
disputed  by  others.  Ordinary  doses  of  alcohol 
have  little  effect  on  the  circulation  in  animals,  but 
clinical  evidence  seems  to  prove  that  alcohol  does 
possess  some  value  in  the  conditions  mentioned, 
particularly  when  a very  brief  respite  for  the  heart 
tides  over  a crisis.  Spirit  of  ether  may  he  given 
by  the  stomach,  or  used  by  hypodermic  injection, 
and  probably  acts  reflexly  on  the  centers  in  such 
cases. 

ERGOT. 

Ergot  has  been  recommended  in  shock  and  in 
hemorrhage  in  inaccessible  locations.  The  use  in 
the  latter  condition  is  based  on  its  undoubted 
power  of  causing  vasoconstriction  in  certain  areas. 
It  is  much  less  useful  than  strychnin  in  shock  be- 
cause of  its  slow  action,  and  in  hemorrhage  there 
is  no  reason  to  expect  a greater  vasoconstriction  at 
the  bleeding  point  than  elsewhere  and  a rise  in  the 
general  blood  pressure  beyond  that  necessary  to 
sustain  the  circulation  in  the  medulla,  is  contra- 
indicated in  hemorrhage.  This,  of  course,  does 
not  apply  to  postpartum  hemorrhage,  because  er- 
got has  a specific  action  on  the  uterus,  causing  a 
firm  contraction  and  thereby  closing  the  bleeding 
vessels  by  compression. 

Sollmann  and  Brown  have  recently  studied  the 
action  of  ergot  when  injected  intravenously  into 
dogs.6  They  found  that  it  influenced  the  general 
circulation  but  little,  particularly  when  the  blood 
pressure  was  much  lowered,  and  that  it  caused  a 

6.  The  Journal  A.  M.  A.,  July  22.  1905,  p.  229. 


CIRCULATORY  STIMULANTS. 


295 


temporary  fall  in  the  blood  pressure  with  speedy 
recovery,  generally  followed  by  an  unimportant 
rise.  The  effects  were  mainly  due  to  the  action 
of  the  heart,  as  the  vasomotor  action  was  very 
slight. 

The  further  discussion  of  its  obstetrical  use  does 
not  belong  here. 

Ergota. — U.  S. — The  sclerotium  of  Claviceps 
purpurea,  gathered  from  rye,  and  not  more  than 
one  year  old. 

While  ergot  has  been  used  in  Germany  for  cen- 
turies as  a household  remedy,  it  was  not  generally 
recognized  as  an  efficient  drug  until  some  time 
after  1777,  when  Desgranges  published  several  es- 
says on  the  use  of  ergot. 

The  vasoconstrictor  properties  of  this  drug  ap- 
pear to  be  due  to  the  alkaloid  cornutin,  discovered 
by  Kobert  in  1884,  and  more  fully  described  by 
Keller  in  1894. 

Extractum  Ergots. — U.  S. — This  is  a hydro- 
alcoholic extract  of  ergot  partially  purified  by  the 
addition  of  hydrochloric  acid  subsequently  neutral- 
ized with  sodium  carbonate.  It  should  represent 
eight  times  its  weight  of  ergot. 

Average  Dose:  0.25  gm.  (4  grains). 

Fltjidextractum  Ergots. — IT.  S. — This  is  di- 
rected to  be  made  with  diluted  alcohol  that  has 
been  acidified  by  the  addition  of  acetic  acid. 

Average  Dose:  2 c.c.  (30  minims). 

Vinum  Ergots. — IT.  S. — This  represents  20 
per  cent,  of  the  fluid  extract  of  ergot  in  fortified 
white  wine. 

Average  Dose:  8 c.c.  (2  fluidrams). 

Ergot  is  preferably  given  in  the  form  of  the 
fluidextract  without  other  additions.  There  are 


296 


PHARMACOPEIA  AND  PHYSICIAN. 


a number  of  water-soluble  preparations  on  the 
market  at  the  present  time  that  are  intended  for 
hypodermic  use,  which,  it  is  claimed,  possess  all  the 
active  principles  of  ergot,  without  the  odorous  and 
nauseating  constituents. 


CHAPTER  XII. 


CIRCULATORY  DEPRESSANTS. 

The  circulation  may  be  depressed  by  acting  on 
those  structures  the  stimulation  of  which  causes  an 
increase  in  blood  pressure.  Hence  we  might  divide 
these  agents  into  two  groups:  1.  Those  acting  on 
the  heart  mainly,  directly  or  through  the  centers. 
2.  Those  acting  for  the  most  part  on  the  vessels, 
directly  or  indirectly. 

An  agent  which  slows  the  heart  without  caus- 
ing a compensating  increase  in  the  strength  or  the 
amplitude  of  the  contraction,  or  a constriction  of 
the  vessels,  must  cause  a fall  in  the  arterial  pres- 
sure, as  will  he  readily  understood  by  reference  to 
what  has  previously  been  said  in  regard  to  acceler- 
ation of  the  heart  causing  a rise  in  pressure.  Here, 
too,  we  have  in  every  case  a combination  of  effects, 
and  the  resulting  change  in  the  circulation  must 
depend  on  the  predominance  of  one  or  another. 
As  a matter  of  fact,  we  have  no  circulatory  depres- 
sant which  is  used  therapeutically  to  slow  the 
heart  by  direct  action  on  the  myocardium,  but 
there  are  a number  which  induce  slowing  by  in- 
direct action. 

ACONITE. 

Therapeutic  doses  of  aconite  cause  slowing  of 
the  heart  by  stimulating  the  vagus  center,  with- 
out materially  affecting  the  strength  of  the  in- 
dividual contractions  or  the  condition  of  the  vaso- 
motor center.  The  result,  therefore,  is  a fall  in 
arterial  pressure. 


298 


PHARMACOPEIA  AND  PHYSICIAN. 


The  lessened  cardiac  action  is  accompanied  by  a 
decline  in  the  temperature,  whether  this  was  pre- 
viously normal  or  that  of  fever.  The  effect  is 
commonly  ascribed  to  the  change  in  the  circula- 
tion, but  it  has  not  been  proved  that  the  heat 
regulating  center  is  not  involved  in  the  action. 

It  will  be  noticed  that  the  effects  of  digitalis 
and  aconite  on  the  circulation  are  diametrically 
opposed,  except  for  the  slowing  of  the  pulse  rate, 
which  both  induce. 

Toxic  doses  of  aconite  act  directly  on  the  heart, 
causing  acceleration  with  diminished  force  of  con- 
traction. In  mammals  the  acceleration  is  pre- 
vented for  a time  by  the  vagus  stimulation,  and  the 
heart  is  actually  slowed,  but  in  reality  only  a 
therapeutic  dose  has  been  absorbed  in  the  early 
stage  of  the  action;  this  stimulation  rapidly  gives 
place  to  depression  and  then  to  paralysis  of  the 
center,  the  acceleration  becoming  marked  and  be- 
ing soon  followed  by  great  irregularity.  Delirium 
cordis  occurs  before  the  heart  stops  in  diastole. 

Paralysis  of  the  respiratory  center  is  usually  the 
immediate  cause  of  death,  hence  atropin  is  capable 
of  saving  a certain  percentage  of  animals  experi- 
mentally poisoned  with  a barely  fatal  dose  of  acon- 
ite. If  an  excessive  dose  has  been  taken  even  ar- 
tificial respiration  will  prolong  life  only  for  a short 
time,  as  the  heart  soon  becomes  paralyzed  after  the 
phenomena  enumerated  above. 

Despite  the  fact  that  it  was  well  known  and 
long  in  use  as  a poison,  particularly  for  wild  ani- 
mals, aconite  is  a comparatively  recent  addition 
to  our  materia  medica,  having  been  introduced  by 
an  Austrian  physician,  Storek.  about  1762. 

Aconitum. — U.  S. — This  is  the  dried  tuberous 


CIRCULATORY  DEPRESSAXTS. 


299 


root  of  Aconitum  napellus,  collected  in  autumn. 
When  assayed  by  the  process  given  in  the  Phar- 
macopeia it  yields  not  less  than  0.5  per  cent,  of 
aconitin. 

Average  Dose:  0.05  gm.  (1  grain). 

The  official  preparations  of  aconite  are  as  fol- 
lows : 

Fluidextractum  Aconite — U.  S. — This  is 
made  with  a mixture  of  75  parts  of  alcohol  and  25 
parts  of  water  and  should  contain  0.4  per  cent, 
of  aconitin. 

Average  Dose:  0.05  c.c.  (1  minim). 

Tinctura  Aconiti. — U.  S. — This  preparation 
has  been  materially  reduced  in  strength  and  now 
represents  10  per  cent,  of  the  crude  drug,  or  ap- 
proximately one-third  of  the  strength  of  the  tinc- 
ture that  was  official  in  the  Pharmacopeia  for 
1890. 

It  may  be  added  that  the  change  was  made  in 
conformity  with  the  recommendations  of  the  inter- 
national conference  for  the  unification  of  formulas 
of  potent  medicaments  and  that,  in  addition  to  be- 
ing in  harmony  with  this  international  standard  it 
will  be  foimd  to  be  more  uniformly  active  than  the 
stronger  but  more  variable  tincture  official  in  the 
earlier  pharmacopeias. 

Average  Dose:  0.6  c.c.  (10  minims). 

Aconitina.- — II.  S. — This  is  an  alkaloid  ob- 
tained from  aconite.  It  is  the  most  active  and  most 
potent  substance  in  the  Pharmacopeia.  The  acon- 
itin  now  official  is  the  crystalline  alkaloid  and 
should  not  be  confounded  with  the  amorphous 
substance  formerly  official  or  the  comparatively 
weak  eclectic  preparation  of  aconite. 


300 


PHARMACOPEIA  AND  PHYSICIAN. 


Average  Dose:  0.00015  gm.  (0.15  mg.  or  1/400 
grain). 

Aconite  finds  its  greatest  usefulness  in  cases  of 
high  blood  pressure  with  a strong,  rapid  heart,  par- 
ticularly in  fever  in  robust  persons.  It  then  simply 
slows  the  heart,  lessening  its  output  and  causing  a 
fall  in  temperature  and  in  arterial  tension. 

Fever  alone  is  not  an  indication  in  every  case  for 
the  use  of  aconite.  In  continued  fevers  and  in  any 
case  in  which  the  heart  is  feeble  or  the  arterial 
tension  low  from  any  cause  (even  though  the 
pulse  may  be  rapid),  aconite  is  contraindicated. 

Since  the  antipyretic  benzene  derivatives  have 
come  into  general  use  the  employment  of  aconite 
in  fever  has  correspondingly  declined,  but  we  have 
seen  that  the  synthetic  antipyretics  are  far  from 
being  the  harmless  substances  that  the  manufac- 
turers  would  have  us  believe,  and  aconite  deserves 
to  be  used  more  frequentty  in  suitable  cases  of 
fever. 

“Colds”  are  troublesome  forms  of  congestion  re- 
sulting from  circulatory  disturbances  which  are 
often  relieved  by  repeated  small  doses  of  aconite. 
For  this  purpose  3 drops  (about  1 minim)  of  the 
tincture  of  aconite  of  the  present  Pharmacopeia, 
which  would  be  equivalent  to  about  1 drop  (1/3 
minim)  of  the  tincture  official  in  the  Pharma- 
copeia, 1890,  well  diluted  with  water,  may  be 
given  every  fifteen  minutes  for  two  hours,  then 
hourly  until  relief  is  obtained. 

Aconitin  is  so  intensely  irritant  that  it  is  not 
suitable  for  use  without  great  dilution,  and  as  there 
is’  some  chance  of  confusing  the  much  more  po- 
tent article  now  official  with  the  eclectic  or  the 


CIRCULATORY  DEPRESSANTS. 


301 


amorphous  preparations,  it  will  be  found  prefer- 
able to  use  the  tincture  of  aconite  in  nearly  every 
case,  more  particularly  since  this  is  now  required 
to  be  of  a definite  aconitin  strength.  Because  of 
its  irritant  action  aconitin  is  not  adapted  for  hy- 
podermic use,  but  it  may  be  given,  largely  diluted 
with  water,  as  follows : 

R.  Aconitin  (crystalline) gr.  1/16  1 004 

Alcoholis  3iv  15 1 

Aquse  q.  s.  ad §iv  120 1 

Sig. : A teaspoonful  may  be  taken  every  three  hours. 

The  disadvantage,  not  to  say  danger,  of  trying 
to  weigh  such  small  amounts  is  apparent,  and 
serves  to  further  illustrate  the  advantage  of  using 
the  tincture. 

The  tincture  is  usually  given  alone,  except  for 
the  water  used  in  diluting  it. 

VERATRUM. 

Yeratrum  rather  closely  resembles  aconite  in  its 
therapeutic  action,  and  it  was  widely  used  at  one 
time  for  the  reduction  of  fever.  The  extent  of  its 
use  was  largely  due  to  its  popularization  in  the 
form  of  Norwood’s  Tincture  of  A7eratrum,  but  it 
seems  to  possess  no  advantage  over  aconite,  and  it 
is  now  but  seldom  used  internally. 

Yeratrum. — IT.  S.  (Yeratrum  Viride. — IT. 
S.  P.,  1890) — Under  the  single  heading  veratrum 
the  Pharmacopeia  now  recognizes  the  dried  rhi- 
zome of  Veratrum  viride  or  of  Veratrum  album. 
While  it  is  true  that  there  is  no  marked  difference 
between  the  two  drugs  some  physicians  prefer  the 
American  root  and  therefore  should  specify  “Yera- 
trum viride,  U.  S.  P.,  1890.” 

Average  Dose:  0.12  gnu  (2  grains). 


302 


PHARMACOPEIA  AND  PHYSICIAN. 


The  official  preparations  are: 

Fltjidextractum  Veratki. — IT.  S. — This  is  di- 
rected to  be  made  with  alcohol. 

Average  Dose:  0.1  c.c.  (1  y2  minims). 

Tinctura  Yeraxri. — U.  S. — This  preparation 
represents  10  per  cent,  of  the  crude  drug  in  alco- 
hol and  is  practically  one-fourth  the  strength  of 
the  corresponding  preparation  in  the  Pharmacopeia 
for  1890. 

Average  Dose:  1.0  cc.  (15  minims). 

Veratrina. — U.  S. — This  is  a mixture  of  alka- 
loids obtained  from  the  seeds  of  Asagrcea  officinalis. 
Veratrin  should  not  be  confounded  with  the  eclec- 
tic preparation  of  the  same  name. 

Average  Dose:  0.002  gm.  (1/30  grain. 

THE  NITRITES. 

The  nitrites,  organic  as  well  as  inorganic,  lower 
the  blood  pressure  by  causing  vasodilation.  Thera- 
peutic doses  exert  but  little  influence  directly  on 
the  heart.  It  has  been  shown  that  the  nitrites  act 
on  the  muscles  and  nerve  endings  of  the  arterioles, 
and  that  even  the  veins  undergo  dilatation. 

Any  considerable  dilatation  of  the  arterioles 
and  veins  of  the  splanchnic  area  must  inevitably 
lead  to  a decline  in  the  general  arterial  pressure, 
regardless  of  the  action  on  the  heart.  In  man 
the  heart  actually  does  show  acceleration  in  the 
first  stage  of  the  action  with  amyl  nitrite  because 
of  the  depression  of  the  vagus  center;  the  blood 
pressure  remains  high  and  the  vasodilation  affects 
the  face  and  neck,  because  of  depression  of  the 
vasoconstrictor  centers  for  those  areas;  but  as  the 
dilatation  extends  to  the  splanchnic  and  other 
areas  the  general  arterial  pressure  falls. 


CIRGULA  TOR  Y DEPRESSANTS. 


303 


There  has  been  some  diversity  of  opinion  in  re- 
gard to  the  effect  of  amyl  nitrite  on  the  cerebral 
circulation.  Leonard  Hill  agrees  with  those  who 
believe  that  there  are  no  nerves  controlling  the  di- 
ameter of  the  cerebral  arteries,  and  he  declares 
that  the  arterial  pressure  in  the  brain  simply  fol- 
lows that  in  the  carotids.  Wiggers  has  found  that 
adrenalin  constricts  the  cerebral  vessels  and  we 
have  Elliott’s  dictum,  based  on  his  masterly  re- 
search, that  the  constrictor  effect  of  adrenalin  on 
vessels  is  proof  of  sympathetic  nervous  control. 
Brodie  and  Dixon  also  found  that  the  action  of 
adrenalin  is  exerted  on  nervous  elements.  Should 
Wiggers’  results  be  confirmed  there  would  be  little 
reason  to  doubt  that  the  nitrites  do  affect  the  cali- 
ber of  the  cerebral  vessels. 

The  nitrites  are  capable  of  causing  some  dilata- 
tion of  the  vessels  in  excised  nruscles  when  the 
nerve  endings  are  not  concerned ; hence  they  must 
also  act  on  the  muscular  elements  of  the  vessels  to 
some  extent. 

The  nitrites  produce  methemogiobin  in  the 
blood,  but  do  not  cause  the  destruction  of'  the  cor- 
puscles, as  other  methemogiobin  formers  do,  and 
in  man  this  does  not  arrest  oxidation  completely, 
because  the  tissues  reduce  methemogiobin  slowly. 
This  is  not  an  important  factor,  however,  with  the 
therapeutic  doses  of  the  nitrites. 

0.  Loeb  suggested  as  a possible  explanation  of 
the  value  of  amyl  nitrite  in  angina  pectoris  that 
the  coronary  vessels,  like  those  of  the  face  and 
brain,  may  be  dilated  at  first,  before  the  action  on 
the  general  circulation  begins.  Filelme  showed 
that  the  therapeutic  dose  of  amyl  nitrite  caused 
vasodilatation  by  central  action,  and  Loeb  found 


304 


PHARMACOPEIA  AND  PHYSICIAN. 


it  did  not  affect  the  vessel  tonus  independently  ex- 
cept when  in  such  concentration  as  to  prove  poison- 
ous. Small  doses  were  found  to  have  no  constant 
effect  on  the  vessels  of  the  coronary  circulation  in 
the  excised  heart.  Amyl  nitrite  acts  very  rapidly 
when  inhaled,  but  the  action  is  over  in  about 
twenty  minutes. 

The  effects  of  glyceryl  trinitrate  or  nitrogly- 
cerin are  much  more  slowly  induced  and  they  per- 
sist for  some  hours.  Sodium  nitrate  is  decomposed 
by  the  hydrochloric  acid  of  the  gastric  juice,  thus 
giving  rise  to  irritation  of  the  stomach.  Glyceryl 
trinitrate  is  not  decomposed  in  the  stomach,  but  it 
has  the  disadvantage  of  often  causing  headache. 
In  some  cases  this  action  does  not  occur  after  the 
drug  has  been  used  for  some  time.  Glyceryl  trini- 
trate is  decomposed  in  the  blood,  with  the  libera- 
tion of  the  nitrous  acid  radicle,  hence  it  acts  like 
the  nitrites. 

Spieitus  Glycerylis  Nitratis. — U.  S. 

(Spiritus  Gloyoini. — IJ.  S.  P.,  1890) — Com- 
monly, though  incorrectly,  termed  nitroglycerin,  is 
an  alcoholic  solution  containing  1 per  cent,  by 
weight  of  glyceryl  trinitrate. 

Average  Dose:  0.05  c.c.  (1  minim). 

Amylis  Nitris. — U.  S. — This  is  a liquid  con- 
taining about  80  per  cent,  of  amyl  nitrite. 

Average  Dose:  0.2  c.c.  (3  minims). 

Sodii  Nitris. — U.  S. — This  usually  occurs  in 
white,  or  nearly  white,  fused  masses,  soluble  in  less 
than  two  parts  of  water.  The  salt  deliquesces  on 
exposure  to  air  and  is  also  gradually  oxidized  to 
sodium  nitrate  and  thus  becomes  unfit  for  use. 

Average  Dose:  0.06  gm.  (1  grain). 


CIRCULATORY  DEPRESSANTS. 


305 


The  nitrites,  and  glyceryl  trinitrate,  are  of 
prime  importance  in  the  depression  of  the  circula- 
tion and  may  be  used  when  it  is  deemed  necessary 
to  lower  the  blood  pressure,  for  example,  when  a 
weakened  heart  is  becoming-  exhausted  by  contract- 
ing against  a great  arterial  resistance,  and  the  con- 
tractions are  incomplete,  as  in  arteriosclerosis.  A 
slight  lowering  of  the  aortic  resistance  often  en- 
ables the  heart  to  contract  more  perfectly  while  a 
coronary  vasodilation  secures  a better  nutrition  of 
the  heart. 

This  group  is  contraindicated,  however,  when 
the  blood  pressure  is  already  low  (however  weak 
and  rapid  the  heart  may  be),  because  a certain  de- 
gree of  arterial  tension  is  absolutely  essential  for 
maintaining  the  coronary  and  medullary  circula- 
tions. 

Amyl  nitrite  is  to  be  preferred  when  a speedy 
action  is  desired,  as  in  acute  attacks  of  angina  pec- 
toris. When  the  constriction  of  the  vessels  is  of 
spasmodic  origin  the  nitrites  usually  give  relief, 
but  in  the  later  stages  of  arteriosclerosis,  when 
most  of  the  muscular  tissue  has  been  replaced  by 
fibrous,  thus  narrowing  the  lumen  of  the  vessels,  it 
is  obvious  that  such  vessels  can  not  be  caused  to 
dilate  by  any  means. 

It  must  not  be  forgotten  that  while  relief  is 
often  obtained  in  the  acute  attacks  of  the  early 
stages  of  angina  pectoris,  the  nitrites  are  merely 
palliative  and  in  no  sense  curative.  The  nitrites, 
and  more  particularly  amyl  nitrite,  are  indicated 
in  vasomotor  spasm  occurring  in  any  disease,  un- 
less specifically  contraindicated  by  other  condi- 
tions. 

The  action  of  amyl  nitrite  is  very  speedily  eli- 


30G 


PHARMACOPEIA  AND  PHYSICIAN. 


cited  when  it  is  inhaled,  but  when  spasm  of  the 
respiratory  muscles  interferes  with  the  inhalation 
it  may  be  injected  into  the  deep  muscles  of  the 
thigh. 

Spirit  of  glyceryl  trinitrate  is  to  be  preferred  in 
chronic  conditions  of  abnormally  high  blood  pres- 
sure, because  of  its  more  protracted  action.  One 
minim  is  given  three  times  a day,  or  the  dose  is 
increased  till  effective.  It  may  be  injected  hypo- 
dermically or  given  by  the  stomach,  as  it  passes 
through  that  organ  unchanged,  and,  therefore, 
causes  no  such  disturbances  as  are  seen  with  so- 
dium nitrite. 

While  this  substance  is  usually  considered  as  be- 
ing extremely  poisonous,  it  is  said  that  more  than 
12  c.c.  (3  fluidrams)  have  been  given  in  the  course 
of  a day  with  no  bad  effects.  Aqueous  solutions 
of  glyceryl  trinitrate  are  unstable  and  are  fre- 
quently quite  worthless.  The  spirit  sometimes 
gives  almost  immediate  relief  in  headache,  when 
this  is  attended  with  high  blood  pressure,  but,  on 
the  other  hand,  it  may  increase  the  headache  if  the 
blood  pressure  is  low.  As  is  well  known  the  head- 
ache which  glyceryl  trinitrate  commonly  causes  is 
one  of  the  greatest  objections  to  its  use. 

The  nitrites,  and  particularly  the  spirit  of 
glyceryl  trinitrate,  may  be  used  to  counteract  the 
vasoconstrictor  effect  of  digitalis  or  strychnin  when 
the  action  is  undesired. 

Because  of  its  ready  decomposition  spirit  of 
nitrous  ether  does  not  yield  enough  of  the  nitrous 
acid  radicle  to  exert  any  therapeutic  action  on  the 
circulation.  The  action  of  the  spirit  is  exerted  re- 
flexlv  as  in  the  case  of  alcohol  and  ether. 

The  spirit  of  nitroglycerin  may  be  given  in 


CIRCULATORY  DEPRESS  AX  TS. 


307 


simple  solution  in  order  to  avoid  the  measuring  of 
such  small  doses  as  one  minim.  It  may  be  pre- 
scribed as  folows : 


R.  Spiritus  nitroglycerini  m.  xv  1| 

Aqu*  gii  60| 


The  dose  of  this  solution  is  a teaspoonful.  Large 
amounts  should  not  be  prescribed  or  dispensed. 

The  following  illustrates  the  method  of  prescrib- 
ing sodium  nitrate: 


R.  Sodii  nitritis  gr.  xv  1| 

Aquae  (recently  boiled)  §ii  601 


This  solution  should  he  kept  well  corked.  The 
dose  is  one  teaspoonful. 

The  well-Jvnown  “pearls”  of  amyl  nitrite  afford 
the  most  convenient  form  for  dispensing  that  sub- 
stance; they  must  be  kept  cool  to  avoid  loss  by 
breakage,  and  when  used,  one  is  crushed  in  a hand- 
kerchief and  the  contents  inhaled  by  the  patient 
at  once. 

Bloodletting  was  formerly  in  vogue  as  a routine 
procedure  when  it  was  desired  to  reduce  the  blood 
pressure,  but  in  healthy  animals  the  vasomotor 
center  exercises  such  perfect  control  over  the  blood 
pressure  that  the  loss  of  blood  produces  very  little 
lasting  effect  unless  it  is  so  great  as  to  cause  col- 
lapse symptoms.  While  the  loss  of  a moderate 
amount  of  blood  is  well  borne  by  robust  patients, 
and  in  some  cases  may  even  prove  beneficial,  acon- 
ite and  the  nitrites  are  nearly  always  to  be  pre- 
ferred as  temporary  measures,  while  the  control 
of  the  diet  (including  liquids)  and  the  use  of 
saline  purgatives  will  serve  to  diminish  the  amount 
of  blood  for  a longer  time  in  suitable  cases. 

Hydrated  chloral  is  one  of  the  most  effective 


308 


PHARMACOPEIA  AND  PHYSICIAN. 


agents  in  onr  possession  for  lowering  the  blood 
pressure  by  depressing  the  vasomotor  centers  and 
while  this  action  is  much  employed  in  laboratory 
experiments,  it  is  not  elicited  in  man  by  perfectly 
safe  doses  such  as  are  used  to  induce  sleep. 


CHAPTER  XIII. 


DIURETICS  AXD  DIAPHORETICS. 

Diuretics  and  diaphoretics  may  be  considered 
together  since  they  are  often  used  for  the  same 
purpose,  the  one  being  used  to  supplement  the 
other,  and  because  the  same  agent  which  produces 
diuresis  under  certain  conditions,  may  cause  dia- 
phoresis when  these  conditions  are  slightly 
changed. 

Diuretics  may  be  divided  broadly  into  those 
which  influence  the  circulation,  and  those  which 
act  on  the  secretory  cells  of  the  kidney.  Though 
the  same  agent  may  possess  both  actions  to  some 
extent,  Ave  shall  consider  these  remedies  with  ref- 
erence . to  the  principal  effect  according  to  this 
classification. 

While  the  exact  mechanism  of  urinary  secretion 
remains  a problem,  the  indications  for  diuresis 
and  the  method  of  causing  it  are  fairly  clear. 
When  the  official  remedies  all  fail  to  produce  this 
effect  we  may  usually  attribute  the  failure  to  the 
condition  of  the  kidney,  feeling  sure  that  the  secre- 
tory cells  are  incapable  of  performing  their  func- 
tion and  that  nothing  short  of  the  creation  of  new 
cells  can  be  effective.  Even  this  task  is  not  beyond 
the  powers  of  some  of  the  much  vaunted  mineral 
waters  and  nostrums  if  we  are  to  believe  the  state- 
ments made  in  the  circulars  and  other  advertise- 
ments of  the  proprietors. 


310 


PHARMACOPEIA  AND  PHYSICIAN. 


Diuretics  are  especially  indicated  in  dropsy  of 
cardiac,  or  even  of  renal,  origin,  provided  the  cells 
are  capable  of  free  secretion.  In  renal  dropsy  agents 
of  the  first  class  (those  which  influence  the  circu- 
lation), or  those  which  mildly  stimulate  the  kid- 
ney cells  without  producing  irritation,  are  to  he 
preferred.  If  the  renal  cells  are  incapable  of  in- 
creased secretion,  diaphoresis  should  be  resorted  to 
in  order  to  give  rest  to  the  kidneys. 

Diuretics  are  also  important  in  causing  the  re- 
moval of  toxins  and  substances  which  form  con- 
cretions (urates  and  phosphates). 

DIGITALIS. 

Nearly  all  authorities  agree  that  digitalis  is  the 
most  important  of  the  official  remedies  in  the 
treatment  of  dropsy  of  cardiac  origin,  its  action 
being  directed  mainly  toward  the  increase  in  the 
efficiency  of  the  heart,  with  a consequently  im- 
proved circulation  in  the  kidney  and  increased 
diuresis.  For  this  purpose  the  tincture  is  fre- 
quently employed,  but,  perhaps,  the  most  efficient 
remedy  is  the  combination  of  digitalis  with  squill 
and  calomel,  commonly  called  Niemeyer’s  pills.1 

The  official  squill  is  too  irritant  to  permit  of  its 
employment  in  nephritis.  This  is  very  important 
and  should  be  borne  in  mind  if  one  uses  any  of  the 


1.  The  formula  for  this  pill  is  as  follows  : 

R.  Pulvis  digitalis 

Pulvis  scilla\  aa grs.  x | GO 

Hydra rg.  chloridi  mit grs.  i % | OS 

This  amount  is  to  he  divided  into  ten  pills,  or  preferably, 
capsules.  One  of  these  pills  every  three  hours  will  be  found 
effective.  The  calomel  is  often  omitted,  or  it  may  be  re- 
placed by  0.06  .g.  m.  (1  grain)  of  the  blue  mass  (massa 
hydrargyri)  in  each  dose,  if  it  is  to  be  made  into  pills,  or 
gray  powder  (hydrargyrum  cum  creta),  if  into  capsules. 


DIURETICS  -USD  DIAPHORETICS. 


311 


much-heralcled  diuretic  nostrums  which  contain 
squill  or  its  active  principles. 

That  squill  is  extremely  active  in  causing  a 
watery  diuresis  is  true,  but  in  overdoses  it  is 
equally  potent  to  lessen  or  even  to  suppress  the 
flow  by  reason  of  its  irritant  action.  This  may 
result  in  bloody  urine. 

The  dose  of  squill,  in  powder,  is  0.05  to  0.1  gm. 
(one  or  two  grains)  every  three  hours  until  some 
nausea  occurs. 

Rather  closely  resembling  digitalis  in  its  action 
on  the  heart  and  as  a diuretic,  if  indeed,  it  may 
not  surpass  the  older  drug  in  the  latter  case,  is 
strophanthus,  which  does  not  cause  the  same  de- 
gree of  vasoconstriction  which  sometimes  interferes 
with  or  prevents  the  diuretic  action  of  digitalis. 
It  is  mostly  used  in  the  form  of  the  tincture. 

While  strophanthus  has  some  advantages,  such 
as  the  more  prompt  action  and  a slighter  tendency 
to  cause  cumulative  effects,  clinicians  have  not 
found  it  so  generally  useful  as  digitalis. 

The  powerful  action  of  strophanthin  as  a local 
anesthetic,  though  denied,  has  been  well  estab- 
lished. 

Apocynum  has  enjoyed  a considerable  reputation 
in  domestic  practice  as  a remedy  in  dropsy,  but 
appears  to  be  inferior  to  digitalis  in  the  same 
group  with  which  it  belongs. 

Digitalis,  strophanthus  and  apocynum  and  other 
preparations  have  been  considered  in  Chapter  XI. 

CAFEEIN. 

When  cardiac  stimulants  or  other  agents  cause 
such  vasoconstriction  as  greatly  to  lessen  the 


312 


PHARMACOPEIA  AXD  PHYSICIAX. 


amount  of  blood  which  passes  through  the  kidney, 
and  consequently  the  diuresis,  a vasodilator  is 
sometimes  employed,  but  it  is  more  rational  to 
avoid  the  necessity  for  this  when  possible. 

When  the  object  of  diuresis  is  to  get  rid  of  fluid 
which  has  accumulated,  it  is,  of  course,  better  to 
avoid  unnecessary  amounts  of  water,  and  in  such 
cases  diuretics  are  given  in  solid,  or  at  least  con- 
centrated, form. 

Caffein  is  the  most  prominent  of  the  official 
drugs  which  produce  diuresis  mainly  by  action  on 
the  kidney  cells.  While  digitalis  may  act  slightly 
on  the  kidney  cells,  but  mainly  on  the  heart, 
caffein,  on  the  other  hand,  acts  mainly  on  the  cells 
of  the  kidney  and  much  less  on  the  heart.  It  may, 
however,  cause  such  considerable  vasoconstriction 
as  seriously  to  lessen  the  amount  of  blood  passing 
through  the  kidney  and  the  diuresis  in  conse- 
quence, in  that  case  the  unofficial  theobromin  might 
be  employed,  as  this  is  said  to  interfere  much  less 
with  the  circulation.  Dr.  G.  1ST.  Stewart  states  that 
caffein  causes  a passing  vasoconstriction  in  the 
kidneys  with  lessened  diuresis,  soon  followed  by 
vasodilation  with  increased  diuresis. 

When  cerebral  excitement  (a  tendency  to  wake- 
fulness) is  to  be  avoided,  caffein  is  contraindi- 
cated. 

Caffein  is  a constituent  of  tea,  coffee,  kola,  and 
more  abundantly  (5  per  cent.),  of  guarana,  which 
is  official. 

Caffein  is  not  very  soluble  in  water  or  alcohol, 
but  its  solubility  in  water  is  greatly  increased  by 
such  salts  as  potassium  bromid,  and  sodium  ben- 
zoate or  salicylate;  this  well-known  fact  has  been 


DIURETICS  AND  DIAPHORETICS. 


313 


appropriated  as  a "discovery”  by  manufacturers 
of  certain  nostrums.2 

Caffeina. — U.  S. — This  is  a feebly  basic  (alka- 
loidal)  substance  obtained  from  Thea  sinensis, 
Coffea  arabica  or  other  plants.  It  does  not  form 
stable  salts. 

Average  Dose:  0.05  gm.  (50  mg.  or  1 grain) . 

Two  other  soluble  forms  of  caffein  are: 

Caffeina  Citrata. — U.  S. — This  consists  of 
equal  parts  of  caffein  and  citric  acid. 

Average  Dose:  0.1  gm.  (2  grains). 

Caffeina  Citrata  Effervescent. — II.  S. — 
This  contains  4 per  cent,  of  citrated  caffein. 

Average  Dose:  4 gm.  (60  grains). 

Diuretin  is  a mixture  of  theobromin-sodium  and 
sodium  salicylate,  while  agurin  consists  of  theo- 
bromin-sodium and  sodium  acetate.  Diuretin  is 
decomposed  on  exposure  to  the  air  and  becomes 
much  less  soluble. 

When  caffein  or  other  diuretics  produce  a more 
than  temporary  vasoconstriction  in  the  kidney,  one 
drop  of  the  1 per  cent,  solution  of  nitroglycerin 
may  be  given  at  the  same  time. 

The  usefulness  of  hot  tea  as  a diuretic  is  too 
well  known  to  require  further  comment. 


2.  The  following  mixture,  to  be  varied  according  to  needs, 
represents  the  method  of  using  caffein  in  this  soluble  form  : 
Caffein  (alkaloid)  | 

Sodium  salicylate,  each 3i  4| 

Cinnamon  water  to  make oiii  100 1 

Each  teaspoonful  contains  about  0.2  gm.  (3  grains)  of 
caffein.  Sodium  benzoate  or  lithium  salicylate  or  benzoate 
may  be  substituted  for  the  sodium  salicylate.  This  formula 
requires  no  unusual  pharmaceutical  skill  to  compound  and  the 
cost  is  very  much  less  than  that  of  the  proprietaries  used 
for  the  same  purpose. 


PHARMACOPEIA  AM)  PHYSIClAX. 


314 

The  official  sugar  of  milk  and  the  unofficial 
urea  cause  diuresis,  probably  by  acting  on  the  renal 
epithelium. 

SCOPARIUS. 

Scoparius. — IT.  S. — This  is  sometimes  incor- 
rectly classed  with  digitalis  because  it  slows  the 
heart,  but  it  weakens  the  beat  while  digitalis 
strengthens  it.  The  alkaloid,  spartein,  is  respon- 
sible for  the  cardiac  and  vasoconstrictor  effect  of 
scoparius,  but  the  diuretic  effect  is  due  to  sc-oparin, 
a glucosid. 

Average  Dose  (of  scoparius)  : 1 gm.  (15  grains) 

The  infusion  or  decoction  is  recommended  for 
producing  diuresis,  except  in  dropsy.3 

Spartein* iE  Sulphas. — IT.  S. — While  this  is  ob- 
tained from  scoparius  it  is  not  a diuretic. 

Average  Dose:  0.01  gm.  (1/5  grain),  but  this 
dose  is  sometimes  considerably  exceeded. 

IRRITANTS. 

Irritants  which  are  excreted  by  the  kidneys  pro- 
duce diuresis  but.  of  course,  they  must  not  be  used 
in  greater  amounts  than  are  necessary  to  produce  a 
mild  stimulation.  They  are  contraindicated  in 
nephritis. 

The  use  of  calomel  in  connection  with  squill  and 
digitalis  has  been  mentioned.  It  is  most  useful  in 
cardiac  dropsy  and  its  use  is  to  be  stopped  when 


3.  Scoparius 

Potassium  bitartrate,  each 3ss  15 1 


This  quantity  of  material  is  to  be  added  to  1 liter  (1 
quart)  of  water,  in  a suitable  vessel,  boil  for  ten  minutes. 
Allow  to  cool  and  strain.  A wineglassful  of  the  resulting 
decoction  may  he  given  every  hour. 


DIURETICS  AND  DIAPHORETICS. 


315 


the  diuresis  becomes  free.  It  may  be  given  in 
doses  of  0.2  gm.  (3  grains)  three  times  daily,  or 
in  the  form  of  Njemeyer’s  pills. 

VOLATILE  OILS. 

The  irritants  include  a number  of  volatile  oils 
which  are  much  more  frequently  used  for  their  an- 
tiseptic action  on  the  urinary  tract  than  for  any 
slight  increase  in  renal  action  which  they  may 
cause.  They  include  such  volatile  oils  as  oil  of 
turpentine  and  oil  of  juniper,  which  are  more  often 
used  as  diuretics  than  copaiba,  cubeb  and  matico, 
which  are  employed  mainly  as  antiseptics. 

HEXAMETHYLEXAMIX. 

The*  volatile  oils  have  been  largely  superseded  as 
urinary  antiseptics  by  the  now  official  hexamethyl- 
enamin.4 

Hexamethylamixa. — IT.  S—  ( Hexamethylen 

tetramin).  This  is  a condensation  product  pro- 
duced by  the  union  of  formaldehyd  and  ammonia. 
While  free  from  the  irritating  effect  of  formalde- 
hyd it  yet  retains  its  antiseptic  properties,  the 
formaldehyd  being  gradually  set  free  by  dilute 
acids.  Being  an  ammonium  derivative,  a solvent 
effect  on  uric  acid  has  been  claimed  for  it,  just  as 
for  lithium  salts.  It  is  readily  soluble  in  water  and 
is  best  given  in  solution. 

Average  Dose:  0.25  gm.  (4  grains). 

This  substance  has  been  introduced  with  some 
slight  modification  under  various  names;  usually 

4.  The  official  name  is  very  cumbersome,  but  no  satis- 
factory substitute  has  thus  far  been  suggested.  Hexamethyl- 
enamin  was  first  brought  before  the  profession  by  Sobering 
under  the  trade  name  of  urotropin  CScbering  & Glatz),  and 
it  is  still  sold  by  them  under  this  name.  It  is  also  on  the 
market  under  various  other  trade  names,  such  as  amniform, 
cystogen  and  others. 


316 


PHARMACOPEIA  AND  PHYSICIAN. 


the  modification  is  only  sufficient  to  enable  the 
manufacturers  to  say  that  their  product  is  not 
identical  with  the  official.  For  instance,  helmitol 
is  anhydromethylen  citric  acid  with  hexamethylen- 
amin.  "[Triform  embraces  two  other  drugs  of  minor 
importance.  The  official  preparation  may  be  con- 
sidered at  least  equal  to  them,  since  it  is  not  mod- 
ified by  any  useless  or  inferior  products,  and  its 
purity  is  easily  insured  by  chemical  tests. 

UVA  URSI. 

Another  drug  of  this  class  which  has  been  the 
subject  of  much  dispute  is  uva  ursi.  Its  principal 
usefulness  is  probably  in  catarrhal  conditions  of 
the  urinary  tract.  It  contains  a glucosid,  arbutin, 
which  is  decomposed,  but  partly  perhaps  in  the 
kidney,  but  more  abundantly  in  contact  with  catar- 
rhal mucous  membrane,  hydroehinon,  an  antisep- 
tic, being  formed. 

Uva  Ursi. — U.  S. — The  dried  leaves  of  Arcto- 
stapliylos  Uva  Ursi,  of  which  the  only  official 
preparation  is : 

Fluidextractum  Uvje  Ursi.- — U.  S. 

Average  Dose:  2 c.c.  (30  minims). 

Infusion  of  uva  ursi  is  made  according  to  the 
general  formula  for  infusions  by  pouring  1 liter 
(1  quart)  of  boiling  water  on  50  gms.  (1  oz.  5 
drs.)  of  bruised  uva  ursi. 

The  fluid  extract  or  the  infusion  may  be  given 
alone  three  or  four  times  daily. 

Chimaphila. — U.  S. — The  dried  leaves  of 
Chimaphila  umbellata , commonly  called  pipsisse- 
wa.  It  was  introduced  in  America  by  Dr.  John  S. 
Mitchell  in  1803,  and  later  into  England. 

Its  medicinal  action  closely  resembles  that  of 


DIURETICS  AND  DIAPHORETICS. 


317 


uva  ursi,  to  which,  however,  chimaphila  is  in- 
ferior. 

Fluidextractum  Chimaphila. — U.  S. 

There  remains  to  be  considered  an  important 
class  of  substances  which  are  used  as  diuretics, 
but  they  are  so  well  known  that  only  a very  brief 
notice  is  needed  here. 

The  acetates  or  citrates  of  sodium  and  potassium 
increase  the  alkalinity  of  the  blood  and  lessen  the 
acidity  of  the  urine  or  render  it  alkaline;  they 
also  increase  diuresis.  Potassium  bitartrate  and 
nitrate  are  also  widely  used  as  diuretics,  mainly 
as  additions  to  mixtures.  For  this  purpose  they 
are  largely  diluted  with  water,  the  latter  alone 
being  the  most  commonly  used  of  all  diuretics. 

Cantharides  is  very  rarely  used  for  its  effect  on 
the  kidneys,  as  it  is  extremely  irritant. 

DIAPHORETICS. 

The  methods  used  for  producing  diaphoresis 
are  analogous  to  those  employed  for  diuresis,  con- 
sisting in  those  which  influence  the  circulation  and 
those  acting  on  the  sweat  glands;  but  in  addition, 
certain  agents,  notably  solution  of  ammonium  ace- 
tate, act  on  the  sweating  center. 

The  circulation  in  the  skin  is  readily  influenced 
by  the  application  of  heat  in  numerous  ways  nnd 
by,  what  amounts  to  the  same  thing,  the  prevention 
of  its  loss  by  an  impervious  cover,  such  as  oiled 
silk,  or  by  agents  which  cause  dilation  of  the  ves- 
sels of  the  skin,  such  as  hot  alcoholic  drinks  and 
spirit  of  nitrous  ether.  Everyone  is  familiar  with 
the  sweating  of  nausea,  and  while  any  nauseant 
will  cause  diaphoresis,  the  only  one  which  is  gen- 
erally employed  for  this  purpose  is  the  powder  of 


318 


PHARMACOPEIA  AND  PHYSICIAN. 


ipecac  and  opium,  the  well-known  Dover’s  powder. 
The  only  official  substance  used  for  the  purpose 
which  directly  stimulates  the  secretion  of  sweat  is 
pilocarpus  and  its  alkaloid,  pilocarpin.  They  do  not 
act  on  the  secretory  cells  as  eaffein  does  or  on  the 
kidney,  but  by  stimulation  of  the  secretory  nerves. 

Diaphoretics  are  employed  to  arrest  “colds”  in 
the  early  stages,  to  aid  in  getting  rid  of  fluid  ac- 
cumulation, as  in  dropsy,  and  to  a lesser  extent  for 
getting  rid  of  secretions.  Diaphoresis  often  serves 
to  relieve  the  kidneys  or  to  supplement  their  ac- 
tion. Vegetable  infusions  which  cause  diuresis 
will  usually  cause  diaphoresis  at  the  same  time  if 
the  patient  is  kept  warm  and  measures  are  taken  to 
increase  the  blood  supply  of  the  surface  (rubbing, 
mustard,  etc.). 

For  the  arrest  of  “colds”  nearly  anything  caus- 
ing sweating  seems  to  be  effective,  but  the  powder 
of  ipecac  and  opium  enjoys  a particular  reputa- 
tion. 

Pulvis  Morphine  Compositus. — U.  S. — Com- 
pound powder  of  morphin,  also  known  as  Tully’s 
powder,  containing  1.5  per  cent,  of  morphin  and  32 
per  cent,  of  camphor,  has  also  been  recommended, 
and  is  sometimes  used,  as  a diaphoretic,  in  place 
of  the  older  and  more  popular  Dover’s  powder. 

Average  Dose  0.5  gm.  (7  grains). 

Potassium  citrate,  referred  to  as  a diuretic,  is 
much  used  for  its  diaphoretic  effect,  particularly 
in  the  form  of : 

Liquor  Potassii  Citratis. — U.  S. — This  is  an 
aqueous  solution  of  potassium  citrate,  containing 
about  8 per  cent,  of  anhydrous  potassium  citrate. 

Average  Dose:  15  c.c.  (4  fluidrachms). 


DIURETICS  AX D DIAPHORETICS. 


310 


Spikitus  AEtheris  Xitrosi. — U.  S. — Sweet 
spirits  of  niter.  This  is  a very  generally  popular 
diaphoretic  which  is  also  used  as  a diuretic  in 
fevers. 

Average  Dose:  2 c.c.  (30  minims).  ' 

Liquor  Ammonii  Acetatis. — U.  S. — The  old- 
time  spirit  of  Mindererus. 

Average  Dose:  15  c.c.  (4  fluidrachms). 

The  only  official  drugs  which  have  diaphoresis 
as  their  predominant  therapeutic  action  are  pilo- 
carpus and  its  alkaloid,  pilocarpin.  They  are  both 
too  well  known  to  require  very  extended  notice  in 
this  place. 

Pilocarpus. — U.  S. — Pilocarpus  or  jaborandi 
leaves  contain,  by  assay,  not  less  than  0.5  per  cent, 
of  alkaloids. 

Average  Dose:  2 gm.  (30  grains),  given  occa- 
sionally in  the  form  of  a 5 per  cent,  infusion, 
made  according  to  the  official  general  formula  for 
that  class  of  preparations. 

Fluidextractuvi  Pii.ocarpi. — U.  S. — This  is 
made  with  diluted  alcohol  and  contains  0.4  per- 
cent of  the  alkaloids  from  pilocarpus. 

Average  Dose:  2 c.c.  (30  minims). 

Pilocarpiyle  Hydrochloridum. — TJ.  S..  and 

Pilocarpenye  Nitras. — U.  S.,  are  therapeu- 
tically identical.  They  are  both  very  soluble  in 
water. 

Average  Dose  (either)  : 0.01  gm.  (1/6  grain). 


CHAPTER  XIV. 


CATHARTICS. 

Cathartics  are  among  the  most  ancient  of  ail 
medicinal  agents,  rhubarb  having  been  in  use 
among  the  Chinese  for  more  than  forty-five  cen- 
turies; senna  and  aloes  were  also  used  in  ancient 
times. 

Liebig  supposed  that  saline  cathartics  in  concen- 
trated solution  withdrew  water  from  the  blood  by 
osmosis,  thus  maintaining  the  feces  in  a liquid  or 
semi-liquid  state.  This  idea  gave  place  to  Schmie- 
deb erg’s  theory,  which  attributes  purgation  to  the 
fact  that  the  purgative  salts,  being  slowly  absorbed 
in  the  small  intestine,  come  into  the  large  intestine, 
where  they  prevent  absorption  of  the  intestinal 
contents,  thus  keeping  the  feces  soft. 

Heidenhain  concluded  that  osmotic  pressure  and 
physiologic  activity  of  epithelium  are  concerned  in 
absorption  from  the  intestine,  and  that  the  retar- 
dation of  absorption  by  salts  is  due  to  a lessen- 
ing of  physiologic  activity. 

Wallace  and  Cushny  studied  the  action  of  ca- 
thartics on  absorption  from  the  intestine,  and 
found  that  those  compounds  which  give  precipi- 
tates with  calcium  salts  retard  absorption  more 
than  others,  and  that  dilute  solutions  of  saline 
cathartics  retard  absorption  of  fluid  from  the  stom- 
ach and  small  intestine,  thus  rendering  the  intes- 
tinal contents  more  fluid  and  more  easily  moved 
through  the  alimentary  canal  by  peristalsis. 

When  Jaques  Loeb  studied  the  effects  of  cer- 
tain salts  which  cause  rhythmic  contraction  of 


CATHARTICS. 


321 


muscle,  he  noticed  that  those  which  produce  mus- 
cular twitching  and  an  increase  in  the  excitability 
of  nerves  are  the  same  as  those  which  produce 
catharsis  when  they  are  introduced  into  the  intes- 
tine. J.  B.  MacCallum  has  found  that  all  the 
saline  purgatives  are  very  much  more  active  when 
injected  into  the  blood,  causing  peristalsis  more 
promptly  and  in  very  much  smaller  doses  than 
when  given  by  the  mouth.  This  is  also  true  of 
their  subcutaneous  injection  or  of  merely  dropping 
the  solution  on  the  peritoneal  surface  of  the  intes- 
tine. He  further  found  that  this  action  is  inhibited 
by  a small  amount  of  calcium  chlorid  or  mag- 
nesium chlorid  solution,  when  it  is  injected,  or 
when  dropped  on  the  peritoneal  surface  of  the  in- 
testine. This  inhibition  is  entirely  analogous  to 
that  which  occurs  with  calcium  chlorid  after 
stimulation  of  skeletal  muscle  by  sodium  citrate 
and  other  salts. 

MacCallum  also  found  that  the  saline  purga- 
tives cause  a greatly  increased  secretion  into  the 
lumen  of  the  intestine;  this  occurs  even  when  ex- 
cised loops  of  intestine  are  suspended  in  saline  so- 
lution, and  he  considers  this  intestinal  secretion  as 
much  the  more  important  factor  in  maintaining 
the  feces  in  a semi-fluid  state.  So  far  from  ad- 
mitting that  the  salines  cause  purgation  by  being 
excreted  into  the  intestine  after  intravenous  injec- 
tion, he  claims  that  they  must  be  absorbed  from  the 
intestine  into  the  blood  in  small  amounts,  at  least, 
before  they  can  cause  increased  peristalsis  and  the 
stimulation  of  the  intestinal  glands  to  increased 
secretion,  pointing,  in  support  of  this  theory,  to 
the  much  more  rapid  action  when  such  small 
amounts  are  injected  into  the  blood  stream,  than 


PHARMACOPEIA  AND  PHYSICIAN. 


:i22 

when  they  are  injected  into  the  stomach  or  intes- 
tine. The  stimulation  of  secretion  and  peristalsis 
in  excised  loops  shows  that  it  may  be  independent 
of  the  central  nervous  system,  and  the  ring-like 
contractions  seen  after  the  application  of  barium 
c-hlorid  points  rather  to  its  action  on  the  muscular 
fibers  than  on  the  nervous  mechanism  of  Auer- 
bach’s or  Meissner’s  plexus,  but  the  precise  seat  of 
the  action  has  not  been  determined.  As  an  ex- 
ample of  the  minuteness  of  the  dose  required  when 
this  drug  is  applied  to  the  peritoneal  surface  of 
the  intestine,  it  is  stated  that  three-fourths  of  a 
milligram  (1/80  grain)  of  barium  c-hlorid  caused 
peristalsis  in  the  rabbit. 

Vegetable  cathartics,  such  as  cascara  sagrada 
and  rhubarb,  were  also  found  to  be  much  more  ef- 
fective when  used  intravenously  or  subcutaneously 
than  when  given  by  the  stomach.  Their  action  is 
also  inhibited  by  calcium  chloric!,  but  to  a less  de- 
gree than  in  the  case  of  salines. 

While  these  experiments  are  interesting  in  ex- 
plaining the  mechanism  of  cathartics,  it  is  not  to 
be  understood  that  the  cathartics  can  be  used  in- 
travenously or  even  hypodermically,  except  in  rare 
cases.  Barium  chloric!  is  ver}r  poisonous,  and  even 
a small  amount  of  magnesium  sulphate  injected 
into  the  blood  would  prove  fatal.  Meltzer  and 
Auer  have  recently  stated  that  magnesium  salts 
immediately  inhibit  intestinal  peristalsis  when  they 
are  injected  into  the  vein  of  an  animal.  MacCal- 
lum’s  work,  on  the  other  hand,  corroborates  that  of 
Claude  Bernard,  who  found  in  1857  that  mag- 
nesium sulphate  caused  peristalsis  when  injected 
subcutaneously. 

Among  the  many  theories  advanced  to  explain 


CATHARTICS. 


323 


catharsis  is  that  of  Groesbeck  Walsh,  who  remarks 
that  the  actions  of  cathartics  in  general  agree  with 
bacterial  action  in  the  liquefaction  of  feces,  in 
causing  increased  peristalsis  and  increased  gas 
formation.  Hence,  he  concludes  that  the  cathar- 
tics act  mainly  by  promoting  bacterial  activity. 
Even  the  action  of  calomel  is  thus  explained,  as  it 
inhibits  the  growth  of  other  bacteria,  thereby  pro- 
moting the  rapid  increase  of  the  colon  bacillus 
with  the  results  just  mentioned. 

The  use  of  purgatives  is  so  general  that  it  is 
usually  considered  a safe  and  harmless  course, 
even  when  it  does  no  good.  This  is  true  in  the 
vast  majority  of  cases,  but  Dr.  M.  L.  Harris  has 
recently  called  attention  to  the  abuse  of  cathartics 
in  conditions  where  they  are  potent  for  much  harm. 
Among  these  he  mentions : Closure  of  the  intes- 

tine, as  by  strangulated  hernia;  complete  local  in- 
testinal paralysis ; localized  spasmodic  constriction, 
which  tends  toward  spontaneous  cure,  but  demands 
opium  rather  than  cathartics ; appendicitis  and 
peritonitis,  in  which  it  is  agreed  that  irritant  ca- 
thartics, at  least,  are  contraindicated,  whatever 
the  individual  opinion  may  be  in  regard  to  the 
use  of  the  salines. 

Among  the  possibilities  for  the  direst  harm  it 
may  be  pointed  out  that  when  a portion  of  the  in- 
testinal tract  is  paralyzed,  which  may  occur  in 
ptomain  poisoning,  active  cathartics  might  pro- 
duce intussusception  by  driving  the  healthy  con- 
tracted bowel  into  the  paralyzed  relaxed  portion. 

CLASSIFICATION-  OF  CATHARTICS. 

There  is  a fairly  sharp  distinction  to  be  drawn 
between  the  action  of  the  irritant  vegetable  ca- 


PHARMACOPEIA  AMD  PHYSICIAN. 


AU 

thartics  and  the  non-irritant  salines.  One  class  of 
the  vegetable  cathartics  depends  for  the  activity  of 
its  members  on  derivatives  of  anthracene,  another 
class  on  resin  anhydrids.  The  preparations  of 
the  crude  vegetable  cathartics  are  usually  but 
slightly  soluble  in  water  and  dilute  acids,  but 
readily  soluble  in  alkalies;  they  are,  therefore, 
not  absorbed  from  the  stomach  to  anjr  great  ex- 
tent, but,  being  soluble  in  the  intestinal  contents, 
they  act  by  irritating  the  bowel,  or  by  being  in  part 
absorbed.  They  are  much  slower  than  salines  in 
their  action,  producing  evacuation  of  the  intestine 
only  after  from  five  to  twenty-four  hours  with 
moderate  doses.  These  facts  are  of  much  im- 
portance in  choosing  a purgative  when  there  is  in- 
flammation of  the  intestine  or  other  abdominal  or- 
gans, as  well  as  in  pregnancy,  since  the  irritation 
of  the  more  drastic  cathartics,  by  extending  to  the 
gravid  uterus,  may  induce  premature  expulsion  of 
the  fetus. 

TREATMENT  OF  CONSTIPATION. 

First  in  the  treatment  of  constipation,  for 
which  purgatives  are  well-nigh  universally  em- 
ployed, stands  diet.  By  this  means  alone  a very 
large  proportion  of  cases  of  chronic  constipation 
might  be  cured.  It  should  contain  a certain 
amount  of  indigestible  residue,  contrary  to  popular 
belief,  and  if  the  patient,  in  addition  to  correcting 
the  diet,  takes  a fair  amount  of  exercise  in  the 
open  air  and  goes  regularly  to  stool,  but  little  pur- 
gative medicine  will  be  needed. 

The  effect  of  stewed  prunes  and  other  fruits  is 
too  well  known  to  require  detailed  mention ; ap- 
ples. figs  and  strawberries  are  equally  useful.  It 


CATHARTICS. 


325 


■ should  also  be  remembered  that  a glass  of  cold 
water,  alone,  taken  on  rising,  will  often  act  as  a 
laxative. 

Such  simple  remedies  should  always  be  tried  be- 
fore resorting  to  drugs  in  chronic  constipation, 
since  the  habit  of  taking  laxatives  in  easily  formed, 
but  not  so  easily  abandoned. 

Hydragogue  cathartics  are  sometimes  used  in 
dropsy  and  to  afford  relief  for  the  kidney. 

The  excessive  development  of  bacterial  poisons 
in  the  intestine  and  their  absorption  into  the  blood 
causes  symptoms  varying  from  mere  lassitude  to 
profound  shock.  Purgatives  sweep  the  bacteria 
and  their  poisons  from  the  canal. 

Diarrhea,  due  to  the  presence  of  irritating  mat- 
ter, such  as  undigested  and  fermenting  food,  is 
often  promptly  relieved  by  a saline  purge.  Saline 
purgatives  are  also  useful  in  reducing  fever,  but 
they  are  not  suited  to  cases  of  the  asthenic  type,  be- 
cause of  the  exhaustion  which  they  produce. 

THE  ANTHRACENE  DERIVATIVES. 

The  vegetable  cathartics  of  the  first  group 
which  we  shall  discuss  depend  for  their  action  on 
substances  derived  from  anthracene.  The  graphic 
formula  of  this  substance  will  help  to  show  the 
relationship  existing  between  several  of  these  de- 
rivatives. Anthracene  (C14H10)  consists  of  three 
benzene  rings  united  thus: 


CH  CH  CH 

/ \ / \ / \ 

HC  C C CH 

I I I I 

HC  C C CH 

\ / \ / \/ 
CH  CH  CH 
Anthracene. 


CH  CO  COH 

/ X / \ / \ 


OHC  C C CCH3 
till 
OHC  C C CH 


\ ✓ \ / \ / 

CH  CO  CH 
Tri-oxy-methyl-anthraquinone. 


If  an  atom  of  H in  the  anthracene  group  is  re- 


326 


PHARMACOPEIA  AND  PHYSICIAN. 


placed  by  one  of  0,  the  compound  is  called  an- 
thraquinone  or  anthrachinone.  Other  atoms  of 
H may  then  be  replaced  by  OH  and  the  compound 
is  called  oxyanthraquinone,  a prefix  to  the  oxy 
showing  the  number  of  such  OH  groups  in  the 
compound ; thus  the  name  tri-oxy-methyl-anthra- 
quinone  indicates  that  four  H atoms  of  anthra- 
quinone  have  been  replaced,  three  by  OH  groups 
and  one  by  a methyl  group  CH,.  This  compound 
is  known  as  emodin. 

Emodin  is  found  in  all  the  drugs  which  owe 
their  activity  to  the  anthracene  derivatives,  but 
its  constitution  may  vary  in  the  arrangement  of 
the  substituted  OH  groups  in  different  plants. 
Natal  aloes  contains  no  emodin,  hence  it  is  not  a 
purgative  for  man,  but  it  is  not  found  in  com- 
merce at  the  present  time. 

Other  members  of  this  group  of  cathartics  con- 
tain other  principles  besides  emodin,  which  are 
derived  from  the  anthracene  nucleus ; thus  chryso- 
phanic  acid,  or  di-oxy-methyl  anthraquinone,  is 
also  found  in  rhubarb,  senna,  rumex  and  probably 
in  frangula.  The  name  indicates  that  there  are 
but  tvro  OH  groups  instead  of  three,  as  in  the  case 
of  emodin. 

Many  other  substances,  the  chemistry  of  which 
is  obscure,  are  found  in  the  cathartic  drugs. 

Preparations  of  the  crude  drugs  contain  colloidal 
matter  which  enhances  the  action  of  the  pure 
principles,  and  they  are  therefore  to  be  preferred 
to  the  latter ; a fact  to  be  remembered  when  read- 
ing the  circulars  of  those  nostrum  makers  who  lay 
stress  on  their  extraordinary  facilities  for  supply- 
ing pure  principles. 

The  drugs  of  the  anthracene  group  are  char- 


CATHARTICS. 


327 


acterized  by  a mildly  irritant  action  whereby  they 
purge  without  producing  inflammation,  hence  they 
are  to  be  preferred  to  the  resin  anhydrids  in 
chronic  constipation,  or  when  a strong  irritant 
action  is  contraindicated. 

Aloe. — U.  S. — Aloes,  including  the  Barbadoes, 
Curasao,  and  the  Socotrine,  is  the  inspissated 
juice  obtained  from  various  species  of  aloe.  It 
was  known  to  the  early  Egyptians  and  Romans. 
One  or  more  of  the  various  species  of  aloes  is  offi- 
cial in  every  pharmacopeia.  Natal  aloes  is  now  in- 
teresting only  from  a scientific  point  of  view. 

Average  Dose  (of  aloes)  : 0.25  gm.  (4  grains). 

Aloe  Purificata. — U.  S. — This  was  made  of- 
ficial in  1860,  because  of  the  impurities  present  in 
Socotrine  aloes,  due  to  the  crude  method  of  col- 
lection. The  dose  is  the  same  as  that  of  aloes. 

Aloinum. — U.  S. — This  is  a neutral  principle, 
varying  in  physical  and  chemical  properties  with 
the  variety  of  aloes  from  which  it  is  obtained.  It 
does  not  fully  represent  the  crude  drug,  medicin- 
ally. 

xAverage  Dose:  0.05  c.c.  (1  grain). 

Extractum  Aloes. — U.  S. — This  is  the  aque- 
ous extract  evaporated  to  dryness. 

Average  Dose:  0.12  gm.  (2  grains). 

PiLTTLiE  Aloes. — U.  S. — Each  pill  contains  0.13 
gm.  (2  grains)  of  purified  aloes  and  an  equal 
amount  of  soap. 

Average  Dose : 2 pills. 

PiLLLiE  Laxative  Compositje. — Each  pill 
contains:  Aloin,  0.013  gm.  (1/5  grain);  strych- 
nin, 0.0005  gm.  (17125  grain)  ; extract  of  bella- 
donna, 0.008  gm.  (1/8  grain)  ; ipecac,  0.004  gm. 
(1/16  grain)  ; and  glycyrrhiza,  0.045  gm.  (2/3 


328 


PHARMACOPEIA  AND  PHYSICIAN. 


grain).  This  is  a substitute  for  the  proprietary 
pills,  which  cinder  a variety  of  names  have  at- 
tained a wide  popularity. 

Average  Dose  (laxative)  : 1 pill. 

The  other  official  preparations  into  which  aloes 
enters  are : Pills  of  Aloes  and  Iron,  Pills  of  Aloes 
and  Mastic  (the  well-known  Lady  Webster’s  Din- 
ner Pill),  Pills  of  Aloes  and  Myrrh,  Compound 
Pills  of  Rhubarb,  Vegetable  Cathartic  Pills  (no 
calomel).  Compound  Cathartic  Pills,  Tincture  of 
Aloes,  Tincture  of  Aloes  and  Myrrh,  and  Com- 
pound Tincture  of  Benzoin.  The  last-named  prep- 
aration does  not  contain  enough  aloes  to  make  it 
useful  as  a laxative.  Pills  of  aloes  are  a convenient 
form  of  administration,  the  soap  furnishing  the 
alkali  needed  for  developing  the  activity  of  aloes. 
The  pill  acts  slowly  and  causes  considerable  pelvic 
congestion,  hence  it  is  useful  in  inducing  delayed 
menstruation  and  increasing  it  if  scanty.  For  the 
same  reason  it,  more  particularly  than  other  mem- 
bers of  the  group,  is  contraindicated  in  fevers, 
pregnancy  and  in  inflammatory  conditions  of  the 
pelvic  organs.  Alone,  it  is  not  so  useful  in  chronic 
constipation,  but  it  is  often  added  to  other  purga- 
tives. The  compound  cathartic  pill  is  the  most 
popular  of  these  combinations. 

Bile  appears  to  increase  the  activity  of  aloes, 
and  the  formula  given  below  is  suggestive  as  a 
suitable  form  of  administration : 

R.  Aloe  | 

Fel  bovis  insp. 

Saponis  aa  gr.  xx  1 1 3 

M.  Ft.  pil.  No.  15.  Sig. : Three  at  a dose. 

These  may  be  coated  with  salol,  to  prevent  their 
disintegration  in  the  stomach.  The  coating  is 


CATHARTICS. 


329 


rapidly  done  by  simply  melting  the  salol  in  a shal- 
low tin  vessel,  into  which  the  pills  are  then  drop- 
ped, and  the  vessel  twirled  until  the  salol  solidifies. 
This  method  of  coating  is  also  applicable  to  other 
so-called  enteric  pills,  which  are  intended  to  dis- 
solve only  in  the  intestine. 

The  tincture  of  aloes  is  so  bitter  that  it  is 
rarely  used  internally,  but  it  is  sometimes  applied 
to  bed  sores  and  other  local  affections.  Aloin 
alone  is  not  so  effective  as  aloes,  but  it  is  ex- 
tremely popular  in  such  combinations  as  the  com- 
pound laxative  pill,  which  acts  mildly  after  about 
sixteen  hours. 

Senna. — U.  S. — The  Alexandria  (short)  and 
the  Tinnivelly,  or  Indian  (long),  senna  are  inclu- 
ded in  the  official  title.  One,  or  both,  of  these  is 
official  in  every  pharmacopeia. 

Average  Dose:  4 gm.  (60  grains). 

Dluidextkactum  Senn2E. — U.  S.— This  is  now 
directed  to  be  made  first  by  removing  the  resin 
with  strong  alcohol  and  subsequently  extracting 
the  drug  with  diluted  alcohol. 

Average  Dose:  2 c.c.  (30  minims). 

Sykupus  Sennas. — IT.  S. — Syrup  of  Senna  is 
now  a very  much  more  acceptable  preparation  than 
was  that  of  the  previous  Pharmacopeia,  and  the 
physician  should  see  that  his  patient  gets  the  better 
article  when  it  is  prescribed. 

It  represents  25  per  cent,  of  the  fluidextract — 
from  which  the  principle  that  causes  griping  has 
been  removed  with  alcohol — with  oil  of  coriander  to 
flavor.  It  supplies  an  excellent  substitute  for  the 
nostrums  now  becoming  obsolete,  which  depend  on 
senna  for  their  activities,  such  as  castoria  and  the 
various  “fig  syrups,”  so  called. 


330 


PHARMACOPEIA  AND  PHYSICIAN. 


For  children  one  or  two  teaspoonfuls  given 
alone  at  bedtime  act  as  a gentle  laxative;  twice 
as  much  may  be  given  as  a cathartic.  For  adults 
twice  as  much  is  given  as  to  children. 

This  preparation  is  not  disagreeable  to  the  taste, 
but  since  children  are  usually  averse  to  anything 
called  medicine,  it  may  be  given  in  a little  cocoa. 

Average  Dose  (as  laxative  for  children)  : 4 c.c. 
(1  fluidrachm). 

PULVIS  GLYCYERHIZiE  COMPOSITUS. — U.  S. — 
This  powder,  previously  mentioned,  contains  18 
per  cent,  of  senna.  It  is  widely  used  as  a laxative. 

Confectio  Senn^e. — U.  S. — This  represents  10 
per  cent,  of  senna,  with  cassia  fistula,  tamarind, 
prune  and  fig.  It  is  substantially  the  same  as 
the  well-known  proprietary  medicine  “Tamar- 
Indien.” 

Average  Dose:  4 gm.  (60  grains). 

Infusum  Senios  Compositum. — U.  S. — For- 
merly known  as  “black  draught”  (not  black  drop). 
This  represents  6 per  cent,  of  senna,  and  12  per 
cent,  each  of  manna  and  magnesium  sulphate, 
flavored  with  oil  of  fennel. 

Average  Dose:  100  to  200  c.c.  (3  to  6 fluid 
ounces). 

The  only  other  official  preparation  containing 
senna  is : The  compound  syrup  of  sarsaparilla. 

Senna  is  one  of  the  best  of  remedies  for  chronic 
constipation,  as  its  use  does  not  entail  a still 
greater  tendency  to  that  condition.  It  has  the  dis- 
advantages of  a disagreeable  taste  and  of  causing 
griping,  if  used  alone : this  tendency  is  overcome 
by  combining  it  with  aromatics.  The  confection 
is  useful  for  children  and  in  pregnancy.  The  milk 
of  the  nursing  mother  who  takes  senna  may  purge 


CATHARTICS. 


331 


the  child.  The  resin  which  causes  griping  may  be 
removed  by  extracting  the  leaves  with  alcohol 
without  loss  of  the  cathartic  principle,  the  official 
fluidextract  being  made  from  senna  which  has 
been  thus  treated. 

The  compound  infusion  or  the  confection  may 
be  used  alone.  The  compound  powder  of  glycyr- 
rhiza  is  an  extremely  popular  laxative. 

Bheum. — U.  S.— Ehubarb  is  obtained  in  Thibet 
and  China  from  sources  still  undetermined.  This 
valuable  drug  has  probably  been  in  use  longer  than 
any  other  substance  now  used  wholly  as  a medi- 
cine. 

Average  Dose:  1 gm.  (15  grains). 

The  official  preparations  of  Ehubarb  are  so 
numerous  that  we  shall  merely  enumerate  them, 
most  of  them  being  too  well  known  to  require  ex- 
tended notice.  They  are : The  Extract,  Fluid- 
eixtract,  Compound  Pills,  Compound  PowdeT, 
Syrup,  Aromatic  Syrup,  Tincture  and  Aromatic 
Tincture. 

The  average  dose  of  either  syrup  is  8 c.c.  (2 
fluidrachms)  ; of  the  tincture,  4 c.c.  (1  fluid- 
rachm)  ; of  the  aromatic  tincture,  2 c.c.  (30  min- 
ims) . 

Ehubarb  is  useful  in  constipation  associated 
with  indigestion  and  catarrh  of  the  small  intestine, 
but  not  in  chronic  constipation,  as  the  tannin 
present  tends  to  increase  the  trouble  after  a time. 
All  of  the  preparations  are  useful,  but  the  aromatic 
syrup  and  the  compound  powder  are  probably  the 
most  popular,  being  especially  useful  in  the  sum- 
mer diarrhea  of  children.  The  extract,  the  fluid- 
extract  and  rhubarb  in  powder  are  all  useful  lax- 
atives. The  compound  pills  are  said  to  be  more 


332 


PHARMACOPEIA  AND  PHYSICIAN. 


useful  in  the  expulsion  of  gas  and  in  chronic  con- 
stipation. They  are  commonly  given  alone.  The 
following  has  been  much  used,  but  it  is  largely 
empirical : 

R.  Extr.  rhei  | 

Ferri  reducti,  aa gr.  lx  4 

Arseni  trioxidi. 

Strychnin®  sulph.,  aa gr.  i 0 1 06 

Quinin®  sulph gr.  lx  4| 

To  be  made  into  40  pills;  one  to  be  taken  before  each 
meal. 

Rhamnus  Purshtanw. — U.  S. — Cascara  Sa- 
grada,  or  “sacred  bark/’  is  directed  to  be  gathered 
a year  before  being  used.  It  was  introduced  into 
medical  practice  in  1877,  but  as  a domestic  rem- 
edy in  habitual  constipation  it  was  in  use  some 
time  before  that  date  in  the  region  to  which  it  is 
indigenous — the  Pacific  slope.  It  is  now  official 
in  a number  of  pharmacopeias.  It  is  not  given 
in  substance. 

Fluidextractum  Riiamxi  Purshiaioe. — U.  S. 
— This  is  prepared  with  40  per  cent,  alcohol. 

Average  Dose:  1 c.c.  (15  minims). 

Fluidextractum  Rhamxi  Purshiasl®  Aro- 
maticum. — U.  S. — The  crude  drug  contains  a bit- 
ter acid  principle  which  is  neutralized  in  this 
preparation  with  magnesia,  orange  and  glycyrrhiza 
being  added  to  flavor  and  sweeten  it.  There  is  no 
special  skill  required  in  making  this  preparation, 
and  any  reputable  pharmacist  can  make  it  equally 
as  well  as  the  manufacturers  who  put  it  on  the 
market  in  the  form  of  proprietary  preparations. 

Average  Dose:  1 c.c.  (15  minims). 

Extractum  Rhamni  Purshiax^e. — U.  S. 

Average  Dose:  0.25  gm.  (4  grains). 


CATHARTICS. 


333 


Cascara  sagrada  is  probably  the  most  useful  lax- 
ative in  the  materia  medica  for  chronic  constipa- 
tion. Unlike  most  of  these  remedies,  which  de- 
mand increasing  doses,  it  improves  the  digestion, 
and  the  dose  may  be  gradually  diminished.  Owing 
to  the  very  disagreeable  taste  of  the  fluid  extract, 
the  aromatic  fluid  extract,  or  the  extract,  in  pills 
or  capsules,  is  to  be  preferred. 

THE  ANHYDRID  GROUP. 

The  active  principles  in  drugs  of  this  group  are 
resinous  in  character;  their  chemistry  is  obscure, 
but  most  of  them  are  known  to  be  glucosids. 
They  cause  violent  irritation  and  even  death  in 
excessive  doses  and  are  not  commonly  used  alone 
unless  a strong  irritant  action  is  desired.  Since 
they  produce  very  watery  stools,  they  are  sometimes 
used  in  dropsy,  or  to  sweep  away  parasites — for 
instance,  after  a narcotic  tenifuge,  such  as  aspi- 
dium. 

Jalapa. — U.  S. — Jalap,  the  dried  tuberous  root 
of  Exogonium  purga,  gathered  in  the  neighborhood 
of  Jalapa,  Mexico,  whence  its  name.  The  drug 
was  introduced  into  Europe  about  1609 ; it  is  now 
official  in  all  pharmacopeias.  The  drug  should 
contain  not  less  than  8 per  cent,  of  total  resin, 
but  not  more  than  1.5  per  cent,  of  resin  soluble  in 
ether. 

Average  Dose  (in  powder)  : 1 gm.  (15  grains). 

Pulvis  Jalaps  Compositus. — U.  S. — This  is  a 
mixture  of  35  parts  of  jalap  and  65  parts  of  potas- 
sium bitartrate. 

Average  Dose:  2 gm.  (30  grains). 

Resina  Jalapje. — U.  S. — That  part  of  the  al- 
coholic extract  which  is  insoluble  in  hot  water. 


PHARMACOPEIA  AX  D PHYSIC  I AX. 


334 

Average  Dose:  0.12  gm.  (2  grains). 

Colocynthis. — U.  S. — The  peeled  dried  fruit 
of  Citrullus  Colocynthis,  a species  of  cucumber. 
As  “Eolokynthis,”  this  drug  was  described  by 
Dioscorides  and  appears  to  have  been  well  known 
even  before  bis  time ; since  then  it  has  been  in  con- 
stant use. 

Average  Dose:  0.05  gm.  (50  mg.  or  1 grain). 

Extractum  Colocynthidis. — U.  S. — 

Average  Dose:  0.030  gm.  (30  mg.  or  % grain). 

Extractum  Colocyntiiidis  Compositum. — U. 
S. — Compound  Extract  of  Colocynth  is  a mixture 
of  16  parts  of  extract  of  colocynth,  50  parts  of 
purified  aloes,  6 parts  of  cardamom,  14  parts  of 
resin  of  scammony  and  14  parts  of  soap. 

Average  Dose:  0.50  gm.  (7%  grains). 

PiLULiE  Cathartics  Composite. — U.  S. — 
Compound  Cathartic  Pills.  Each  contains : 


Comp.  ext.  of  coloevnth . . . 

. . . .gr.  iss 

108 

Mild  mercurous  clilorid . . . 

gr.  i 

1 06 

Resin  of  jalap 

. . gr.  1/3 

1 02 

Gamboge  

..  gr.  1/4 

|015 

Average  Dose : 2 pills. 

Piluls  Cathartics  Vegetabiles. — TJ.  S. — 
Vegetable  cathartic  pills.  Each  contains : 

Comp.  ext.  of  colocynth gr.  i 1 06 

Ext.  of  hvoscyamus gr.  ss  ! 03 

Resin  of  jalap gr.  1/3  |02 

Ext.  of  leptandra 

Resin  of  podophyllum,  aa.  . . .gr.  1/4  1 015 

Oil  of  peppermint m.  1/8  ] 008 

Average  dose:  2 pills. 

Scammonium. — U . S. — Scammony,  a gum- 
resin  obtained  by  incising  the  living  roots  of  Con- 
volvulus Scammonia,  has  been  known  and  properly 
esteemed  as  an  active  cathartic  for  over  20  cen- 
turies. 


CATHARTICS. 


335 


Average  Dose:  0.250  gm.  (4  grains). 

Resina  Scammonii. — U.  S. — Resin  of  Scam- 
mony  is  that  portion  of  the  gum-resin  that  is 
soluble  in  alcohol,  but  insoluble  in  water. 

Average  Dose:  0.200  gm.  (3  grains). 

Podophyllum. — IT.  S. — Podophyllum,  popular- 
ly known  as  mandrake  root  or  May  apple,  is  said 
to  have  been  used  by  the  American  Indians,  but 
the  statement  has  been  repeatedly  questioned. 

Average  Dose:  0.500  gm.  (7%  grains). 

Fluidextractum  Podopilylli. — U.  S. 

Average  Dose:  0.5  c.c.  (8  minims). 

Resina  Podophylli. — IT.  S. 

Average  Dose  (purgative)  : 0.015  gm.  (15  mg. 
or  14  grain)  ; (laxative)  : 0.005  gm.  (5  mg.  or  1/10 
grain). 

Leptandra. — IT.  S. — Is  rarely  used  in  sub- 
stance. 

Extractum  Leptandra. — IT.  S. 

Average  Dose:  0.25  gm.  (4  grains). 

Fluidextractum  Leptandrye. — IT.  S. 

Average  Dose:  1 c.c.  (15  minims). 

Euonymus. — IT.  S. — Euonymus  is  the  dried 
bark  of  the  root  of  Euonymus  atropurpureus. 

The  Extract  (dose  0.12  gm.  or  2 grains),  and 
the  Fluidextract  (dose  0.5  c.c.  or  8 minims)  are 
also  official. 

Elaterinum. — IT.  S. — Elaterin,  a neutral  prin- 
ciple obtained  from  elaterium,  a substance  depos- 
ited by  the  juice  of  the  fruit  of  Ecballium  Ela- 
terium. 

Average  Dose:  0.005  gm.  (5  mg.  or  1/10  grain) 

The  therapeutics  of  the  anhydrid  group  may  be 
treated  together,  as  the  action  of  the  different  mem- 


33fi 


PHARMACOPEIA  AMJ  PHYSICIAN. 


bers  is  very  similar  and  there  are  few  indications 
for  one,  rather  than  another,  in  a particular  case. 

They  are  all  used  to  some  extent  in  dropsy, 
but  elaterium  is  the  most  effective  of  all  in  the 
removal  of  water.  They  cause  depression,  and 
when  this  is  severe  it  demands  a stimulation. 

They  are  rarely  used  alone;  thus  scammony, 
which,  in  overdoses,  has  caused  death,  is  used  in 
the  compound  cathartic  pill;  jalap  is  often  com- 
bined with  calomel  or  with  potassium  bitartrate, 
in  the  compound  jalap  powder,  which  is  adminis- 
tered alone.  An  example  of  the  combination  of 
calomel  with  jalap  is  the  calomel  and  jalap  pow- 
der of  the  National  Formulary,  which  consists  of: 

Calomel  %\  32 1 

Jalap  3ii  64 1 

The  dose  is  about  1 gm.  (15  grains),  or  a 
smaller  amount  may  be  given  and  repeated  at  in- 
tervals of  several  hours. 

Eesin  of  jalap  is  nearly  tasteless  and  is,  there- 
fore, often  given  to  children ; it  may  be  mixed  with 
a little  sugar  for  the  purpose. 

Compound  cathartic  pills  are  so  well  known  that 
they  scarcely  require  further  notice.  The  soap 
present  (in  compound  extract  of  coloeynth)  slowly 
reduces  the  mercurous  chlorid  to  the  black  oxid — 
increasing  its  effectiveness. 

Podophyllum  has  been  called  “vegetable  calo- 
mel” and  it  was  supposed  to  increase  the  secretion 
of  bile,  but  this  is  not  probable.  It  causes  purga- 
tion after  ten  to  twelve  hours  and  is  very  useful  in 
acute  constipation. 

A suitable  form  of  administration  is  suggested 
below,  but  the  possible  combinations  are  endless. 


CATHARTICS. 


337 


The  Triplex  Pills  (N.  P.)  have  the  following 
formula : 


R.  Purified  aloes  gr.  ii  |12 

Mass  of  mercury gr.  i 1 060 

Eesin  of  podophyllum gr.  1/4  J 015 


Dr.  John  W.  Francis  has  used  a pill  containing 
about  1 grain,  each,  of  purified  aloes,  scammony 
and  mass  of  mercury,  with  1/20  minim  of  croton 
oil,  minim  of  oil  of  caraway  and  enough  tinc- 
ture of  aloes  and  myrrh  to  make  one  pill. 

Leptandra,  euonymus  and  some  other  official 
vegetable  drugs  cause  purgation,  but  do  not  re- 
quire special  mention  here. 

Cambogia. — U.  S. — Camboge  is  a gum-resin  ob- 
tained from  Garcinia  Hanburii. 

Average  Dose:  0.12  gm.  (2  grains). 

PURGATIVE  OILS. 

There  are  but  two  of  these  which  merit  discus- 
sion here.  Castor  oil  and  croton  oil  owe  their  ac- 
tivities to  two  acids,  ricinoleic  in  the  castor  oil, 
and  crotonoleic  in  the  croton  oil.  The  acid  does 
not  exist  uncombined  in  castor  oil,  but  is  liberated 
when  it  reaches  the  intestine,  forming  new  com- 
pounds which  are  irritant  and  therefore  purga- 
tive. 

Crotonoleic  acid  does  exist  free  to  a small  extent 
in  croton  oil,  which  is,  therefore,  irritant  even 
when  applied  to  the  skin. 

Other  bland  fixed  oils  are  sometimes  used  as 
laxatives.  Among  those  which  are  official  are 
Olive  Oil,  Cotton  Seed  Oil,  and  Expressed  Oil  of 
Almond. 

Oleum  Eicini. — U.  S. — Castor  Oil,  expressed 
from  the  seed  of  Ricinus  communis,  is  a pale,  yel- 


338 


PHARMACOPEIA  AND  PHYSICIAN. 


lowish  or  almost  colorless,  transparent,  viscid 
liquid,  having  a faint  mild  odor,  but  an  offensive 
taste.  It  was  known  to  the  ancients,  but  fell  into 
disuse ; it  was  again  brought  into  notice  in  1764 
by  a West  Indian  physician,  who  described  it  as  a 
gentle  purgative. 

Average  Dose:  15  c.c.  (4  fluidrachms). 

Castor  oil  is  very  useful  in  ordinary  constipa- 
tion, and  often  in  diarrhea,  when  it  serves  to  re- 
move the  irritating  substance. 

Owing  to  the  widespread  repugnance  to  the  taste 
of  castor  oil,  many  means  have  been  devised  for 
disguising  it.  If  the  mouth  is  merely  rinsed  with 
strong  whisky,  the  oil  may  be  swallowed  without 
discomfort.  For  children  it  is  given  in  the  form  of 
soda  water  with  syrup  of  sarsaparilla,  or  with 
ginger  ale,  when  it  is  often  swallowed  without  the 
child’s  knowledge. 

The  following  formula  is  useful  for  disguising 
the  taste : 

R.  Spts.  menth.  pip 3iiss  1 0 1 

01.  ricini  q.  s.  ad Siii  100  [ 

Sig. : 15  c.c.  (4  fluidrachms)  to  be  taken  without 

further  dilution. 

Emulsions  of  castor  oil  have  never  been  popular, 
as  they  but  imperfectly  disguise  the  taste.  Soft 
capsules,  containing  15  minims  each,  may  be 
swallowed,  and  many  persons  find  them  unobjec- 
tionable. Three  or  four  capsules  are  given  at  bed- 
time. 

Oleum  Tiglii. — U.  S. — Croton  Oil.  A pale, 
brownish-yellow,  fixed  oil,  expressed  from  the 
seeds  of  Croton  Tiglium;  it  has  a slight  fatty  odor, 
and  a mild,  oily,  afterward  acrid  and  burning 
taste.  (Great  caution  is  necessary  in  tasting). 


CATHARTICS. 


339 


Average  Dose:  0.05  c.c.  (1  minim). 

Owing  to  its  irritant  character  and  the  violence 
of  its  action,  croton  oil  is  not  generally  used  as  a 
purgative,  but  there  are  conditions  in  which  it  is 
very  useful;  it  may  be  given  in  apoplexy,  when 
the  patient  is  unconscious,  a drop  being  placed  on 
the  tongue  either  in  the  form  of  an  emulsion  or 
on  sugar.  It  is  useful  when,  from  any  cause, 
there  is  difficulty  in  administering  a bulky  ca- 
thartic, but  it  is  contraindicated  in  inflammatory 
conditions  of  the  intestines. 

Croton  oil  is  also  applied  to  the  skin  as  an  irri- 
tant. 

LAXATIVE  SWEET  SUBSTANCES. 

Some  of  the  following  substances  may  be  treated 
under  the  subject  of  dietetics,  since  they  are  laxa- 
tive mainly  because  of  the  bulk  of  non-absorbable 
matter.  The  dose  is  large  and  the  action  mild — 
with  the  exception  of  Cassia  Fistula,  which  is  apt 
to  cause  griping. 

Manna. — U.  S. — The  concrete  saccharine  exu- 
dation of  Fraxinus  ornus.  It  consists  mainly  of  a 
peculiar  sugar,  mannite. 

Average  Dose:  16  gm.  (240  grains). 

Prunum. — U.  S. — Prune,  the  partly  dried 
fruit. 

Tamarindus. — U.  S. — The  preserved  pulp  of 
the  fruit. 

Average  Dose:  15  gm.  (i/o  ounce). 

Ficus. — U.  S. — The  partially  dried  fruit. 

Cassia  Fistula. — U.  S. — The  dried  fruit. 
This  and  the  three  preceding  articles  enter  into 
confection  of  senna. 


340 


PHARMACOPEIA  AND  PHYSICIAN. 


Manna  is  a mild  laxative,  but  it  is  rarely  used 
alone ; it  enters  into  the  compound  infusion  of 
senna. 

BILE. 

Since  many  of  the  symptoms  resulting  from  in- 
digestion and  constipation  were  formerly  attrib- 
uted to  a deficiency  in  the  formation  of  bile, 
agents  were  sought  which  would  increase  its  secre- 
tion. Many  of  the  purgatives  now  in  common 
use  were  supposed  to  possess  this  property,  but 
the  only  agent  which  has  been  shown  by  experi- 
ment to  increase  the  secretion  notably  is  bile  itself. 

The  precise  role  played  by  bile  beyond  the 
splitting  of  fats,  is  still  a moot  point. 

In  this  connection  it  may  be  mentioned  that  the 
mineral  acids,  particularly  the  dilute  nitro-hydro- 
chloric,  have  been  much  used  for  their  supposed 
cholagogne  action;  this  is  too  slight  to  give  them 
practical  value,  but  they  are  useful  in  many  con- 
ditions for  which  a deficiency  of  bile  is  supposed 
to  be  the  cause. 

Dr.  Philip  Shaffer  recently  gave  a woman  with 
biliary  fistula  about  20  gms.  (5  drams)  of  the 
purified  ox  bile  in  three  days,  resulting  in  a notable 
increase  of  bile  secretion. 

The  patient’s  general  condition  seemed  to  be 
but  little  affected  by  the  absence  of  bile  from  the 
intestine,  but  fats  were  not  so  well  borne  as  in  a 
normal  person.  This  but  confirms  the  experience 
of  other  observers,  and  in  this  light  cholagogues 
lose  much  of  their  importance. 

Fel  Bovis. — D.  S. — The  fresh  bile  of  the  ox  is 
only  used  in  the  form  of : 


CATHARTICS. 


341 


Fel  Bovis  Perifacttevi. — U.  S. — Its  use  has 
already  been  mentioned. 

Average  Dose : 0.5  gm. 

PHENOLPHTHALEIjST. 

Phenolphthalein  is  not  official  as  a medical  sub- 
stance, but  is  mentioned  in  tlie  Pharmacopeia,  in 
the  list  of  reagents  and  test  solutions,  as  an  indi- 
cator in  a nidi  mi  try. 

It  has  attracted  some  attention  of  late  as  a laxa- 
tive. In  combination  with  soap  and  salicylic  acid, 
it  is  being  widely  advertised  under  the  name  of 
“Probilin.”1 

SALI3STE  CATHARTICS. 

A salt  may  be  defined  as  a substance  resulting 
from  the  chemic  union  of  an  acid  with  a base. 
For  the  present  purpose  we  shall  exclude  from 
this  classification  salts  of  alkaloids  and  of  other 
popular  conception  of  salts,  or  purgative  salts, 
organic  bases,  and  confine  our  definition  to  the 
- The  purgative  salts,  in  contrast  to  the  antiquity 
of  many  of  the  vegetable  cathartics,  are  of  but 
comparatively  modern  use,  ma'ny  of  the  inorganic 
salts  being  introduced  into  Europe  by  the  Moors, 
but  not  coming  into  general  use  until  after  the 
time  of  Paracelsus. 

1.  The  proprietors  of  probilin  quote  Dr.  W.  Bauermeister 
of  Brunswick,  Germany,  as  authority  for  the  assertion  that 
salicylic  acid  and  sodium  oleate  are  the  most  powerful 
cholagogues.  This  is  not  in  accord  with  the  generally  ac- 
cepted opinion  of  therapeutists.  The  same  authority  states 
that  he  had  the  two  drugs  put  up  in  pills  containing  iy2 
grains  of  each,  adding  menthol  and  phenolphthalein  as  anal- 
eptics and  to  mildly  stimulate  intestinal  activity.  But  we' 
are  unable  to  understand  why  he  should  add  “these  pills, 
named  probilin,  are  difficult  to  prepare.”  At  least,  any  com- 
petent American  pharmacist  can  readily  prepare  them.  Three 
or  four  of  these  pills  taken  before  retiring  are  said  to  be 
effective. 


342 


PH  ARM  A COPE  [A  AND  PHYSICIAN. 


Most  of  the  purgative  salts  have  a disagreeable, 
bitter  taste,  but  when  taken  in  an  effervescing 
draught  this  bitterness  is  masked,  and  the  efferves- 
cent salts  have  therefore  come  into  great  popular- 
ity. The  widespread  use  of  nostrums  of  this  type, 
instead  of  the  official  effervescent  salts  prepared  by 
the  pharmacist,  illustrates  an  unfortunate  condi- 
tion which  exists  without  a sufficient  reason.  There 
is  too  much  distrust  of  the  pharmacist  by  certain 
physicians,  who  complain  that  pharmacists  are  un- 
able to  supply  preparations  equal  to  those  of  the 
nostrum  maker.  This  may  possibly  be  true  in 
isolated  cases,  hut  the  proof  to  the  contrary  is  fur- 
nished by  the  extreme  simplicity  of  the  prepara- 
tion of  the  effervescent  salts  which  the  average 
pharmacist  can  prepare  quite  as  well  as  the  large 
manufacturer.  Nevertheless  the  nostrums  of  this 
class  have  an  enormous  sale. 

It  is  unfortunately  true  that  the  physician  often 
lacks  confidence  in  himself  and  prefers  to  use  the 
ready-made  mixtures  rather  than  to  exercise  his 
own  choice.  This  is  degrading  alike  to  medicine 
and  to  pharmacy. 

It  is  a part  of  our  present  purpose  to  illustrate 
the  ease  with  which  the  physician  may  choose  his 
own  agents  in  the  proportion  which  seems  best 
adapted  to  each  individual  case,  with  the  assurance 
that  any  honest  pharmacist  can  compound  his 
prescription  in  a form  equal  in  efficiency  and  ele- 
gance to  the  nostrums. 

The  preparation  of  the  effervescent  salts  de- 
pends on  the  fact  that  tartaric  and  citric  acids  and 
sodium  bicarbonate  may  he  kept  in  contact  with- 
out change  when  dry,  but  unite  with  effervescence 
when  they  are  dissolved  in  water. 


CATHARTICS. 


343 


As  an  example  of  the  ease  with  which  efferves- 
cent salts  are  prepared,  we  give  directions  for  mak- 
ing one,  which,  though  extremely  simple,  is  still 
the  most  complex  of  those  which  are  official — The 
Effervescent  Magnesium  Sulphate.  The  same  di- 
rections, with  slight  modifications,  are  used  in  pre- 
paring the  other  official  granular  effervescent  salts 
and  may  be  used  when  it  is  desired  to  include  other 
salts  or  even  caffein  and  similar  substances. 

The  magnesium  sulphate  is  dried  over  a water 
bath,  powdered  and  mixed  with  powdered  citric 
and  tartaric  acids,  then  with  the  sodium  carbonate ; 
the  mixture  is  heated  to  about  95°  C.  in  a dish 
placed  in  an  oven  until  it  becomes  moist ; it  is  then 
rubbed  through  an  ordinary  tinned  iron  sieve 
(which  forms  it  into  granules).  These  are  then 
dried  at  a temperature  of  54°  C. 

Does  it  seem  credible  that  any  pharmacist  is  un- 
able to  make  so  simple  a preparation  as  that  ? 

Many  of  the  nostrums  that  are  offered  to  physi- 
cians as  effervescent  saline  mixtures  are  not  even 
granulated,  and  some  of  them,  at  least,  depend  en- 
tirely on  the  use  of  the  cheaper  tartaric  acid  and 
sodium  bicarbonate  to  produce  effervescence.  Mix- 
tures of  this  kind  can  be  prepared  extemporane- 
ously quite  as  readily  as  the  frequently  prescribed 
liquid  preparations. 

Constipation  is  by  far  the  most  common  com- 
plaint of  those  who  live  in  cities.  While  the 
rational  treatment  consists  in  attention  to  the  diet 
and  other  hygienic  measures,  for  the  most  part, 
it  is  so  much  easier  to  read  one  of  the  innumer- 
able advertisements  which  depict  the  terrible  con- 
sequences of  constipation,  and  the  one  certain 
means  of  escape  therefrom,  that  the  credulous  are 


344 


PHARMACOPEIA  AND  PHYSICIAN. 


inclined  to  accept  such  statements  as  true,  and,  in 
a way,  lionize  themselves  because  of  the  dangers 
they  have  encountered  and  escaped. 

Any  attempt  merely  to  enumerate  the  financially 
successful  nostrums  of  this  type  involves  one  in 
immediate  difficulties,  because  of  the  enormous 
number  of  those  advertised  to  the  public,  while 
those  of  this  type  advertised  to  physicians  are 
scarcely  less  numerous. 

The  principal  purgative  salts  and  their  indica- 
tions are  so  well  known  that  we  shall  confine  our- 
selves mainly  to  enumerating  some  of  them,  with 
suggestions  for  the  forms  in  which  they  are  avail- 
able, and  a few  of  the  combinations  which  may  be 
found  useful.  We  shall  have  occasion  to  contrast 
the  well-known  actions  of  these  drugs  with  the 
absurd  claims  made  for  some  of  the  nostrums 
which  they  compose. 

Magnesii  Sulphas. — IJ.  S. — Epsom  Salt  (by 
which  name  it  is  most  widely  known)  is  so  called 
because  it  was  formerly  obtained  by  evaporating 
the  water  of  Epsom  Springs.  It  is  one  of  the  chief 
constituents  in  many  famous  purgative  waters, 
such,  for  instance,  as  the  Hunyadi  of  Hungary. 

Average  Dose:  15  gm.  (4  drams). 

Magnesii  Sulphas  Efeebvescens. — U.  S. — 
(Its  preparation  has  been  detailed.) 

Average  Dose:  15  gm.  (4  drams). 

Magnesii  Cakbonas. — U.  S. — A bulky,  white, 
colorless  and  nearly  tasteless  powder,  which  is  in- 
soluble in  ordinary  solvents. 

Average  Dose:  3 gm.  (45  grains). 

Magnesii  Oxidum. — U.  S. — This,  commonly 
called  magnesia,  or  calcined  magnesia,  closely  re- 
sembles the  carbonate  in  its  several  properties. 


CATHARTICS. 


345 


Average  Dose:  2 gm.  (30  grains). 

Magnesii  Oxidum  Poxderosum. — U.  S. — This 
differs  from  the  preceding  only  in  being  more 
dense,  and  therefore  requiring  a less  bulky  dose. 
It  was  formerly  known  as  Husband’s,  also  as 
Henry’s  magnesia. 

Average  Dose:  2 gm.  (30  grains). 

Liquor  Magnesii  Citratis. — H.  S. — This,  al- 
most always  called  “citrate  of  magnesia,”  is  one  of 
the  most  agreeable  of  the  purgative  preparations, 
but  it  does  not  keep  well,  and  should  therefore  be 
ordered  freshly  prepared. 

Average  Dose  (as  purgative)  : 360  c.c.  (one  bot- 
tle). 

Magnesium  carbonate  is  frequently  employed  as 
an  ant-acidq  the  oxids,  light  and  heavy,  are  ant- 
acid and  laxative.  The  oxids  should  be  given  with 
a large  excess  of  water.  They  are  much  used  for 
children. 

Potassii  et  Sodii  Tartras. — H.  S. — This  is 
commonly  called  Rochelle  salt  because  it  was  first 
manufactured  in  the  city  of  Rochelle.  It  was  dis- 
covered by  a pharmacist  named  Seignette  and  is 
often  called  Seignette  salt  by  the  French. 

Average  Dose:  8 gm.  (120  grains). 

Pulvis  Effervescens  Compositus. — U.  S. — 
Seidlitz  powder  is  the  form  in  which  Rochelle  salt 
is  most  often  used. 

Sodii  Phospkas. — H.  S. — This  has  come  into 
very  general  use  of  late  years  in  the  treatment  of 
chronic  constipation,  and  it  is  popularly  believed  to 
exert  a special  influence  on  the  liver.  It  is  soluble 
in  about  six  parts  of  water. 

Average  Dose:  2 gm.  (30  grains). 


340 


PHARMACOPEIA  A. XL)  PHYSICIAN. 


Sodii  Pi-iospiias  Eppervescens. — U.  S.— This 
is  much  more  pleasant  to  take  than  the  ordinary 
sodium  phosphate,  of  which  it  contains  20  per 
cent. 

Average  Dose:  8 gm.  (120  grains). 

Sonir  Phosphas  Exsiccates. — U.  S. 

Average  Dose:  1 gm.  (15  grains). 

A preparation  so  well  known  as  sodium  phos- 
phate requires  little  therapeutic  notice.,  but  we 
wish  to  offer  some  suggestions  as  to  the  forms  in 
which  it  is  available. 

The  effervescent  salt  leaves  little  to  be  desired 
when  one  wishes  to  employ  it  as  a laxative,  but  it 
is  not  well  adapted  for  use  with  hot  water. 

We  give  below  several  examples  of  its  combina- 
tion. In  one  of  these  lithium  citrate  is  used.  Of 
course,  these  combinations  may  be  endlessly  varied, 
using  the  dried  magnesium  sulphate,  for  instance, 
instead  of  the  dried  sodium  phosphate. 

Catfein  is  often  used  with  effervescing  salts, 
and  this  or  other  similar  substances  ma}r  be  incor- 
porated without  materially  changing  the  formulas. 


It.  Lithii  citratis  . 3i  4|0 

Sodii  phosph 3viii  30 1 0 

Sodii  bicarb 3x  40 10 

Acidi  tartarici  3vi  25 1 0 


The  dose  of  this  is  about  4 gm.  (60  grains). 

For  use  with  hot  water  the  following  extem- 
poraneously-prepared mixture  is  preferable  to  the 
official  effervescent  salt: 


It-  Potassii  bitart 3x  40 1 0 

Sodii  bicarb 3v  20  0 

Sodii  phosph.  exsic 3x  40] 0 


The  dose  of  this  preparation  is  the  same  as  that 
of  the  one  preceding  it.  In  ease  a more  alkaline 


CATHARTICS. 


347 


mixture  is  desired  the  amount  of  sodium  bicarbon- 
ate may  be  slightly  increased  and  the  potassium 
bitartrate  correspondingly  decreased. 

Liquor  Sodii  Phosphatis  Compositus. — U. 
S. — One  c.c.  represents  1 gram  of  sodium  phos- 
phate. 

Average  Dose:  8 c.c.  (2  fluidrachms). 

To  make  this  solution,  the  Pharmacopeia  directs 
that  100  gm.  of  sodium  phosphate  and  4 gm.  of 
sodium  nitrate  be  triturated  together  in  a mortar 
with  13  gm.  of  citric  acid,  until  completely  lique- 
fied, then  sufficient  water  is  to  be  added  to  make 
the  product  measure  100  c.c. 

Although  this  requires  no  more  skill  than  the 
weighing  of  the  salts,  the  Alta  Chemical  Company 
pretends  that  it  thus  secures  “An  Ideal  Nerve 
Tonic,  Laxative,  Analgesic ! Stimulant  of  Gland- 
ular Function,  adjuvant  to  all  organic  remedies 
indicated  in  the  organism ! relieving  Hepatic  Con- 
gestion, supporting  Sexual  Power,  regulating 
both  excretion  and  secretion  on  a normal  physio- 
logic basis !” 

The  indications  enumerated  are  far  too  absurd 
to  be  repeated  in  full,  but  as  an  example  of  this 
word  waste  we  quote  the  following:  “Especially 
reliable  as  a painless  cure  for  the  Morphin  Habit !” 
Does  this  insolent  company  suppose  that  we  are 
bereft  of  every  vestige  of  intelligence  when  it  in- 
sists on  telling  us  such  manifest  falsehoods  as  we 
have  quoted  or  that  Rheumagon,  consisting  of 
sodium  iodid  and  sodium  phosphate,  is  “a  specific 
in  all  cachectic  diseases  l” 

Surely.  Baron  Munchausen,  in  his  wildest  flights 
of  fancy,  never  imagined  anything  more  preposter- 
ously absurd. 


348 


PHARMACOPEIA  AND  PHYSICIAN. 


When  we  see  how  simple  is  the  preparation  of 
the  various  effervescent  salts,  and  remember  that 
the  Pharmacopeia  provides  reasonably  high  stand- 
ards and  readily  applied  tests  for  the  purity  of  all 
official  salts,  with  which  all  reputable  manufactur- 
ers of  chemicals  comply,  we  see  how  absurd  is  the 
pretense  of  the  nostrum  makers  that  they  have 
special  processes  and  peculiar  facilities  for  manu- 
facturing products  of  superior  quality. 

Liti-iii  Carbonas. — U.  S. — It  is  more  than 
sixty  years  since  Lipowitz  announced  that  this 
salt  favored  the  solution  of  uric  acid.  Since  then 
the  lithium  salts  have  been  widely  used,  especially 
in  combination  with  purgatives  and  diuretics,  but 
there  is  no  evidence  that  any  benefits  result  from 
such  combinations. 

The  lithium  salts  are  of  comparatively  little  im- 
portance according  to  the  accepted  authorities  in 
therapeutics  of  to-day. 

Average  Dose:  0.5  gm.  (8  grains). 

Lithii  Citras. — IT.  S. — Is  used  for  the  same 
purposes  and  in  the  same  dose  as  the  carbonate. 

Lithii  Citras  Effervesced. — IT.  S. — Is  a 
convenient  form  for  administering  the  citrate. 

Average  Dose:  8 gm.  (120  grains). 

Lithium  salicylate  was  made  official  in  1880  be- 
cause of  its  asserted  superiority  in  the  treatment  of 
acute  rheumatism;  it  possesses  no  advantages  over 
the  other  salicylates,  but  the  nostrum  makers  hav- 
ing seized  on  it  while  the  first  reports  of  its  success- 
ful use  were  being  circulated,  they  continue  to 
make  the  most  extravagant  claims  for  it  in  their 
preparations.  Cushny  specifically  denies  that  this 
salt  has  any  especial  solvent  action  on  uric  acid  in 
acute  rheumatism;  this  should  be  borne  in  mind 


CATHARTICS. 


349 


when  free  circular  pharmacology  is  under  consider- 
ation. 

Sal-lithin  is  typical  of  a host  of  nostrums  which 
consist  of  lithium  and  purgative  salts.  It  is  made 
by  the  firm  which  exploits  the  thoroughly  dis- 
credited bioplasm  by  such  absurd  misstatements 
and  reprehensible  methods.  (See  The  Journal, 
vol.  xlv,  pp.  1587-1812.) 

The  number  of  uric  acid  solvents,  each  of  which 
is  the  “most  powerful  known,”  is  truly  surprising. 
It  is  still  more  surprising  that  mankind  continues 
to  suffer  from  rheumatism  and  gout,  nearly  as 
much  as  they  did  before  these  “discoveries”  were 
made. 

Mr.  J.  LeRoy  Webber,  Ph.G.,  is  credited  by  the 
Bristol-Myers  Co.  with  originating  sal  hepatica, 
the  really  “most  powerful”  one.  This  truly  won- 
derful discovery  of  Mr.  J.  LeRoy  Webber,  Ph.  G., 
is  also  useful,  so  we  are  told,  in  the  treatment  of 
“Fullness  of  Blood,”  likewise  “Acidity  of  the 
Stomach,”  though  most  of  us  prefer  some  acidity 
of  the  stomach  and  not  a little  blood  to  fill  our 
arteries. 

If  further  literature  of  a similar  nature  is  de- 
sired, we  suggest  the  careful  reading  of  the  ITric 
Acid  Monthly , particularly  with  regard  to  the 
munificent  offer  for  reports  “suitable  for  publica- 
tion.” 

It  must  be  evident  to  the  least  observant  that 
we  are  drifting  far  from  the  safe  course  in  thera- 
peutics when  men,  who  have  not  sufficient  knowl- 
edge to  avoid  absurdities  so  glaring  that  they  be- 
come apparent  on  the  first  appeal  to  reason,  ex- 
ploit our  profession  and  use  us  to  dupe  the  public. 
Are  we  to  continue  in  this  degrading  position  or 


350 


PHARMACOPEIA  AND  PHYSICIAN. 


are  we  to  assert  our  independence  and  demand 
common  sense,  at  least,  from  those  who  seek  to 
serve  ns  ? The  arrogance  of  the  nostrum  vendors 
under  the  cloak  of  servility  is  become  insupport- 
able, and  physicians  should  no  longer  tolerate  such 
abuses. 

While  we  have  divided  the  cathartics  (under 
which  term  we  include  laxatives)  into  two  gen- 
eral classes,  vegetable  and  saline,  this  has  been 
done  merely  for  convenience  of  grouping,  and  we 
shall  now  take  up  the  more  important  laxatives 
and  cathartics  which  have  not  been  discussed. 

Hydrargyrum  Cum  Creta,. — U.  S. — Gray 
Powder. — This  contains  38  per  cent,  of  mercury 
(metallic)  mechanically  mixed  with  clarified 
honey  and  prepared  chalk. 

Average  Dose:  0.25  gm.  (4  grains). 

Massa  Hydrargyri. — IT.  S. — The  well-known 
“blue  mass”  contains  33  per  cent,  of  mercury 
(metallic)  combined  with  glyeyrrhiza,  althea,  gly- 
cerin, and  honey  of  rose. 

Average  Dose:  0.25  gm.  (4  grains). 

Hydrargyri  Chloridum  Mite.- — H.  S. — Calo- 
mel is  required  by  the  Pharmacopeia  to  contain 
at  least  99.5  per  cent,  of  pure  mercurous  ehlorid. 

There  is,  perhaps,  no  drug  which  is  better  known 
than  calomel,  and  we  can  afford  to  give  it  space 
in  inverse  proportion  to  its  importance. 

Average  Dose  (as  a laxative)  : 0.12  gm.  (2 
grains) . 

Despite  the  widespread  use  of  the  mercurials, 
their  mode  of  action  remains  a problem.  Some 
authorities  assert  that  calomel  must  be  converted 
into  the  oxid.  others  that  small  amounts  of  the  bi- 
chlorid  are  formed,  and  that  this  is  the  active 


CATHARTICS. 


351 


agent.  The  effect  on  the  organism  is  not  less  a 
matter  of  dispute ; pharmacologists  usually  deny 
that  it  causes  an  increase  of  bile-flow,  as  experi- 
ments, made  by  careful  observers,  on  both  man 
and  animals  with  biliary  fistula,  have  failed  to 
demonstrate  any  increase.  Calomel  acts  as  an  an- 
tiseptic and  the  bile  is  thus  protected  from  decom- 
position, while  the  increased  peristalsis  affords  less 
time  for  its  absorption.  Some  of  the  older  clin- 
icians, however,  still  hold  to  the  theory  that  it 
really  does  increase  the  amount  of  bile  secreted  by 
the  liver.  However  calomel  may  act,  it  is  the  best 
remedy  we  possess  for  that  form  of  indigestion  and 
constipation  which  is  frequently  called  “bilious- 
ness.” 

Mercury  and  chalk,  commonly  called  gray  pow- 
der, does  not  occasion  so  much  nausea  as  the  other 
mercurials  in  common  use,  and  is  usually  preferred 
for  children  who  suffer  with  indigestion  and  con- 
stipation with  considerable  intestinal  putrefaction. 

The  mercurials  are  contraindicated  in  chronic 
conditions,  such  as  tuberculosis,  and  in  the  latter 
months  of  pregnancy.  The  use  of  calomel  as  a 
diuretic  has  been  mentioned,  and,  while  Wood  pro- 
nounces it  useful  in  chronic  parenchymatous 
nephritis,  others  maintain  that  it  is  injurious, 
and  Sollmann  has  recently  suggested  that  great 
conservatism  should  be  exercised  in  its  employ- 
ment. At  any  rate  it  should  not  be  used  merely 
for  its  purgative  effect  when  nephritis  exists,  or 
only  with  great  caution. 

Sulphur  Precipitatum. — IT.  S. — Sulphur 

Sublimatum. — IT.  S. — and  Sulphur  Lotum. — TJ. 
S. — These  are  the  three  forms  in  which  Sulphur  is 
now  official.  Either  the  sublimed  or  the  washed 


352 


PHARMACOPEIA  AND  PHYSICIAN. 


may  be  used  as  a laxative.  The  sulphur  is  slowly 
converted  in  the  intestine  into  the  sulphid,  only  to 
a small  extent,  which  acts  as  an  irritant,  while  the 
greater  part  of  the  sulphur  remains  insoluble  and 
acts  mechanically— merely  by  its  bulk.  Washed 
sulphur  is  an  ingredient  of  compound  powder  of 
glycyrrhiza. 

Average  Dose  (of  any  of  the  three  forms  of  sul- 
phur) : 4 gm.  (60  grains). 


CHAPTEE  XV. 


PARASITICIDES  AND  ANTIGONOR- 
EHEICS. 

It  will  be  convenient  to  consider  under  this 
head,  agents  used  for  parasites  other  than  bacteria, 
which  infest  the  skin  and  intestines,  together  with 
a brief  reference  to  the  antigonorrheics. 

Cleanliness  prevents  nearly  all  hurtful  skin 
parasitism,  and  the  only  one  which  we  shall  con- 
sider here  is  that  of  the  pediculi,  since  other  forms 
are  commonly  treated  more  advantageously  by  the 
specialist. 

The  louse  which  infests  the  head  requires  no 
medication,  since  it  is  easily  removed  with  a fine 
comb  and  thorough  washing  with  tar  soap.  The 
ointment  of  red  mercuric  osid  or  red  precipitate 
has  been  used  as  a popular  domestic  remedy,  and 
the  tincture  of  larkspur  or  of  stavesacre,  to  be  men- 
tioned again  later,  may  be  useful  in  many  cases. 

The  louse  which  infests  the  genital  regions, 
Pediculus  pubis,  is  smaller  and  more  difficult  to 
remove  mechanically. 

A dilute  solution  of  mercuric  chlorid  (corrosive 
sublimate)  is  sometimes  used  and  is  very  effective 
for  this  troublesome  parasite.  It  should  not  be 
stronger  than  one  to  five  hundred  (2  grains  to  2 
fluidounces  or  0.1  gm.  to  50  c.c.),  and  this  should 
be  used  cautiously.  A less  cleanly  but  very  effi- 
cient remedy  is  mercurial  ointment. 

A 20  per  cent,  tincture  of  staphisagria,  or 
larkspur,  diluted  with  water,  bay  rum,  dilute  alco- 


354 


PHARMACOPEIA  AND  PHYSICIAN. 


hoi  or  soap  liniment  is  much  used  in  some  parts  of 
the  country. 

Among  the  names  of  staphisagria  which  indicate 
its  common  use  are  semen  staphidis  pedicularis 
and  lausekorner. 

In  lieu  of  the  unofficial  tincture  the  now  offi- 
cial : 

Fluidextractum  Staphisagria. — U.  S. — Di- 
luted with  from  8 to  10  parts  of  soap  liniment,  or 
of  bay  rum,  will  be  found  equally  serviceable. 

It  may  not  be  amiss  to  call  attention  to  the  fact 
that  carbolic  ointment  not  only  kills  the  trouble- 
some chigger,  but  also  relieves  the  smarting  which 
that  parasite  occasions,  or  which  is  more  fre- 
quently caused  by  scratching  the  place  where  the 
parasite  is  embedded. 

ANTHELMINTICS. 

The  term  anthelmintic,  meaning  literally 
against  a worm,  embraces  vermifuges  and  tenia- 
fuges,  which  expel  the  round  and  tape  worms,  re- 
spectively, and  vermicides  and  tenicides  which  kill 
them;  but,  as  a matter  of  fact,  the  parasites  are 
rarely  killed  before  their  expulsion. 

Kiiehenmeister  attempted  to  establish  a rational 
basis  for  the  use  of  anthelmintics,  more  than  fifty 
years  ago,  but  his  work,  which  was  widely  quoted 
for  a long  time,  has  but  little  value  at  present. 

v.  Schroeder  studied  the  effects  of  a large  num- 
ber of  agents  on  ascarides  and  found  that  the  lat- 
ter are  remarkably  resistant  to  poison  placed  in  the 
media  with  the  parasites,  which  are  to  a certain  ex- 
tent able  to  resist  absorption.  These  parasites  are 
surrounded  by  a chitinous  substance,  and  when 
that  is  not  acted  on  by  the  agent  the  mouth  is  the 


PARASITICIDES,  ANTI GONORRHE ICS.  355 

principal  means  of  ingress  to  tlieir  bodies.  San- 
tonin, even  in  concentrated  solution,  was  found  to 
be  harmless  to  the  parasite,  which,  however,  found 
it  objectionable  and  sought  to  escape  from  the  so- 
lution containing  it,  the  movements  being  partic- 
ularly active;  from  this  it  would  appear  that  san- 
tonin drives  the  round  worm  out  of  its  normal 
habitat  into  the  large  intestine,  from  which  it  must 
be  swept  by  purgation. 

The  statement  that  the  presence  of  castor  oil 
greatly  increased  the  toxicity  of  santonin  for  this 
parasite  arose  from  a mistake,  and  santonin  is 
now  usually  given  with  calomel.  Since  it  is  not  in- 
tended to  be  dissolved  in  the  stomach,  a compressed 
tablet  or  lozenge  of  calomel  and  santonin  is  to  be 
preferred.  For  the  same  reason,  when  santonin  is 
given  to  a child,  with  a little  sugar,  the  two  sub- 
stances should  be  lightly  rubbed  together  without 
being  powdered.  Sodium  santoninate  which  is  sol- 
uble, should  not  be  used,  therefore,  and  it  has,  very 
properly,  been  dismissed  from  the  later  editions  of 
our  Pharmacopeia. 

The  following  are  among  the  now  official  sub- 
stances that  are  useful  as  vermifuges. 

Santonica. — IT.  S. — Santonica  or  Levant  worm 
seed,  as  it  is  frequently  called,  is  officially  de- 
scribed as  the  dried  unexpanded  flower  heads  of 
Artemisia  pauciftora.  It  is  now  seldom  employed 
as  such,  being  generally  displaced  by: 

Santoninum.— IT.  S. — Santonin,  the  inner  an- 
hydride or  lactone  of  santonic  acid,  obtained  from 
santonica,  was  discovered  in  1830,  by  two  German 
apothecaries,  quite  independently  of  each  other, 
Kaliler  in  Diisseldorf,  and  Alms  in  Mecklenburg. 

Average  Dose:  0.06  gm.  (1  grain). 


356 


PHARMACOPEIA  AND  PHYSICIAN. 


Spigelia.- — U.  S. — Spigelia  or  pink  root  is  the 
dried  rhizome  and  roots  of  Spigelia  marilandica. 

Average  Dose:  4 gm.  (60  grains). 

Fluidextractum  Spigelle. — U.  S. — This  is 
made  with  diluted  alcohol  and  is  the  preparation 
now  generally  used  when  this  drug  is  to  be  admin- 
istered. 

Average  Dose:  4 c.c.  (1  fluidrachm). 

Oleum  Chenopodii. — U.  S. — Oil  of  Chenopo- 
dium  is  a volatile  oil  distilled  from  Clieno podium 
anthelminticum,  more  popularly  known  as  Amer- 
ican wormseed. 

Average  Dose:  0.2  c.c.  (3  minims). 

Quassia. — U.  S. — The  wood  of  Picrasma  ex- 
celsa,  Jamaica  quassia,  or  of  Quassia  amara,  Sur- 
inam quassia,  is  more  frequently  used  in  the  form 
of  a decoction  or  an  infusion,  made  in  accordance 
with  the  general  formulas  for  these  several  prep- 
arations. 

Average  Dose:  0.5  gm.  (7%  grains). 

Extractum  Quassia. — IT.  S. — This  is  an 
aqueous  extract  and  represents  ten  times  the 
weight  of  the  crude  drug. 

Average  Dose:  0.06  gm.  (1  grain). 

Fluidextractum  Quassia. — U.  S. — This  is 
directed  to  be  made  with  a mixture  of  three  parts 
of  alcohol  and  six  parts  of  water. 

Average  Dose:  0.05  c.c.  (8  minims). 

Tixctura  Quassia. — IT.  S. — This  is  a 20  per 
cent,  tincture  and  is  made  with  35  per  cent,  alco- 
hol. 

Average  Dose:  2 c.c.  (30  minims). 

The  Ascaris  lumbricoides,  or  round  worm,  is 
a very  common  parasite  in  the  small  intestine  of 
children  particularly.  The  most  useful  remedy 


PARASITICIDES,  ANTI  GONORRHE  ICS.  357 


for  this  parasite  is  santonin;  this  has  been  given 
in  a variety  of  methods.  Some  authorities  recom- 
mend from  one-half  to  one  grain  (0.02  to  0.05 
gm.)  morning  and  evening  during  three  days  for 
a child  and  on  the  fourth  day  a purgative.  This 
suggestion  was  evidently  based  on  the  supposition 
that  the  parasites  were  killed  or  injured  and  were 
then  to  he  swept  out,  but  since  we  know  that  this 
is  not  true,  the  method  in  vogue  at  the  present 
time  is  to  combine  santonin  with  a slowly  acting 
purgative,  such  as  calomel  in  small  doses.  The 
purgative  should  follow  the  santonin  in  a few 
hours  at  the  latest.  It  should  be  remembered  at 
all  times  that  santonin  is  not  an  absolutely  safe 
remedy  and  that  it  is  far  better  to  try  a small  dose 
and  to  repeat  it  in  a few  days  if  not  effective  than 
to  give  the  maximum  dose  in  the  beginning. 

A lozenge  containing  half  a grain  (0.03  gm,) 
of  santonin  given  morning  and  evening,  to  a child, 
for  three  days  will  usually  be  found  effective. 
Twice,  this  dose  is  used  for  an  adult. 

If  it  is  desired  to  give  santonin  in  powders,  it 
may  be  prescribed  somewhat  as  follows : 


Santonini  (ervst.)  

. , . .grs.  iii 

012 

Saeehari  

. .grs.  xxx 

2| 

M. 

Ft.  in  chart.  No.  vi  div. 

Sig. 

: One  powder  night  and 

morning,  the 

last  dose 

to  be  followed  by  a purgative. 

The  purgative  may  consist  of  calomel  or  syrup 
of  senna,  or,  according  to  the  more  modern  teach- 
ing, 1/6  grain  (0.01  gm.)  of  calomel  may  be  di- 
rected to  be  incorporated  in  each  paper.  The  mix- 
ture should  be  dispensed  in  granular  form  and  not 
finely  powdered.  Santonin  taken  in  this  way  has 
very  little  taste. 


358 


PHARMACOPEIA  AND  PHYSICIAN. 


While  santonin  is  perhaps  the  most  effective 
remedy  we  have  for  ascarides,  the  fluidextract  of 
spigelia  has  been  recommended  and  is  said  to  act 
somewhat  like  santonin.  It  is  recommended  that 
a laxative  be  given  before  the  spigelia  and  a pur- 
gative some  hours  later,  or  the  combination  of  pink 
root  and  senna,  that  was  at  one  time  quite  com- 
mon, may  be  preferred. 

Spigelia,  however,  has  also  given  rise  to  toxic 
symptoms  in  children. 

Oil  of  chenopodium,  or  oil  of  American  worm- 
seed,  has  long  enjoyed  a certain  reputation,  par- 
ticularly as  a household  remed}r,  for  round  worms. 
It  has  a very  disagreeable  odor  and  taste.  It  may  be 
given  combined  with  eastor  oil,  or  from  one  to 
three  drops  may  be  mixed  with  sugar  for  a child. 

The  thread  worm  or  pin  worm,  Oxyuris  vermic- 
ularis,  infests  the  rectum  and  colon,  and  is  often 
spoken  of  as  the  seat  worm. 

The  common  anthelmintics,  such  as  santonin, 
together  with  purgatives,  are  usually  effective  in 
removing  them,  but  they  sometimes  prove  very 
troublesome  and  difficult  to  dislodge. 

Injections  of  large  amounts  of  watery  infusions 
are  often  useful.  Infusion  of  quassia  enjoys  an  es- 
pecial reputation,  it  lessens  the  mucus  secretion 
and  probably  increases  the  movements  of  the  para- 
sites, which  facilitates  their  removal  when  the 
bowel  is  emptied. 

As  suggested  in  connection  with  the  official 
preparations  of  quassia,  an  aqueous  infusion,  the 
extract  or  even  a correspondingly  diluted  fluidex- 
tract may  be  used,  with  some  promise  of  satisfac- 
tory results,  in  cases  in  which  the  infusion  can  not 
be  readily  obtained. 


PARASITICIDES,  ANTIGONORRHEICS.  359 

Phenol  has  also  been  recommended,  but  the 
danger  of  absorption  entirely  precludes  its  com- 
mon use. 

Osier  recommends  the  cold  injection  of  a strong 
solution  of  common  salt  for  children,  repeated  for 
ten  days  at  least.  The  hips  are  elevated  to  favor 
the  retention  of  the  injection  as  long  as  possible. 

TENIAE  ITGES. 

Eemedies  used  for  tape  worm  are  commonly 
spoken  of  as  teniafuges,  even  though  the  parasite 
may  belong  to  a different  genus,  but  as  a matter  of 
fact,  the  Tania  saginata,  which  is  derived  from 
beef,  is  very  much  more  commonly  found  in  the 
human  intestine,  while  Tania  solium  from  swine 
is  met  with  much  less  frequently  in  man. 

Bomriocephalus  latus  is  mentioned  in  all  test- 
books,  but  as  it  is  extremely  rare  in  this  country, 
and  practically  never  originates  here,  it  may  be 
disregarded  in  this  place. 

Male  fern,  or  the  much  more  widely  used  oleo- 
resin.  which  fully  represents  the  rhizome,  is  said 
to  be  very  much  less  efficacious  against  the  Tania 
than  against  the  Bothriocephalus , while  pelletierin, 
obtained  from  the  bark  of  pomegranate  root,  is  es- 
pecially efficacious  against  the  Taenia.  If  this  be 
true  we  have  but  another  example  of  our  tendency 
to  take  everything  originating  in  Germany  as  be- 
ing universally  correct,  without  exercising  our  own 
judgment,  for  male  fern  has  certainly  enjoyed  a 
greater  popularity  than  the  circumstances  appear 
to  justify.  On  the  other  hand,  its  wide  use  in 
northern  Germany  is  more  rational,  since  the 
Bothriocephalus  is  very  commonly  found  there  in 
man. 

Yon  Schroeder  found  that  one  part  of  pelletierin 


300 


PHARMACOPEIA  AND  PHYSICIAN. 


in  ten  thousand  parts  of  a solution  containing  1 
per  cent,  each  of  sodium  chlorid  and  sodium  car- 
bonate, was  very  rapidly  fatal  to  Toenia  serrata  and 
to  Toenia  inermis,  while  much  stronger  solutions 
were  practically  harmless  to  round  worms. 

Estimating  the  content  of  the  human  intestine 
at  200  c.c.  after  purgation,  if  only  0.2  gm.  (3 
grains)  of  pelletierin  escape  absorption  from  the 
stomach  and  pass  into  the  intestine,  it  would  be 
present  in  the  proportion  of  one  part  in  one  thou- 
sand of  intestinal  content,  or  ten  times  the  concen- 
tration found  necessary  by  von  Schroeder. 

Pelletierin  is  but  mildly  toxic  to  man,  hence  it 
appears  to  be  an  almost  ideal  teniafuge  or  teni- 
cide. 

Kamala,  which  was  formerly  official,  and  is  still 
used,  acts  as  an  intestinal  irritant,  causing  purging 
and  therefore  requiring  no  subsequent  purgative. 
It  is  said  to  be  effective  against  tenia  and  is  usually 
administered  in  substance,  being  given  in  doses  of 
from  4 to  8 gm.  (one  to  two  drachms). 

Kosotoxin,  obtained  from  kousso,  resembles  male 
fern  in  its  pharmacologic  action,  but  is  said  to  be 
efficacious  against  Toenia  as  well  as  against  Botli- 
riocephalus. 

Aspidium,  or  male  fern,  has  repeatedly  given 
rise  to  toxic  symptoms  and  death  has  occasionally 
followed  its  use.  It  is  apparently  inferior  to  pome- 
granate in  the  treatment  of  tenia,  and  there  seems 
to  be  little  reason  for  giving  it  the  preference. 

Filicic  acid  was  formerly  regarded  as  the  active 
principle;  however,  it  seems  that  there  are  a num- 
ber of  principles  which  share  the  action. 

Pumpkin  seed  enjoys  some  reputation  as  a 
teniafuge,  but  it  is  not  often  prescribed  alone. 


PARASITICIDES,  ANTIGOKORRHEICS.  361 


It  lias,  at  least,  the  advantage  of  not  being  toxic 
to  the  patient. 

SOME  OFFICIAL  SUBSTANCES  USED  AS  TENIAFUGES. 

Aspidium. — IT.  S. — Aspidium,  or  male  fern,  the 
dried  rhizome  of  Dryopteris  Felix-mas  or  of  Dry- 
opteris  marginalis,  Mas  known  to  Dioscorides,  and 
advocated  by  him  as  being  an  efficient  remedy  for 
tape  worm,  but  fell  into  disuse  and  was  subse- 
quently nearly  forgotten  until  revived  as  a secret 
remedy,  for  the  same  parasite,  about  the  middle  of 
the  eighteenth  century. 

Average  Dose:  4 gm.  (60  grains). 

Oleoresina  Asptdii. — U.  S. — Oleoresin  of  As- 
pidium is  now  directed  to  be  made  with  acetone. 
This  preparation  was  first  suggested  by  Peschier  of 
Geneva,  about  1825,  and  has  gradually  displaced 
the  other  preparations  of  male  fern. 

Average  Dose:  2 gm.  (30  grains). 

Granatum.- — U.  S. — Pomegranate,  the  bark  of 
the  stem  and  root  of  Punica  Granatum,  was  also 
known  to  the  ancients  as  a remedy  for  tape  worm. 
It  appears  to  have  been  completely  forgotten  and 
was  introduced  into  Europe  from  India  during  the 
first  decade  of  the  nineteenth  century. 

Average  Dose:  2 gm.  (30  grains). 

Fluidextractum  Granati. — U.  S. — Fluidex- 
tract  of  Pomegranate  is  made  with  a menstruum 
of  diluted  alcohol  containing  10  per  cent,  of  gly- 
cerin. 

This  is  a new  addition  to  the  Pharmacopeia  and 
has,  as  yet,  not  been  widely  used. 

Average  Dose:  2 c.c.  (30  minims). 

Pelletier  in  je  T annas. — IT.  S. — Pelletierin 
Tannate  is  officially  described  as  a mixture,  in 
varying  proportions,  of  the  tannates  of  four  alka- 


362 


PHARMACOPEIA  AND  PHYSICIAN. 


loids  (punicin,  iso-punicin,  methyl-punicin  and 
pseudo-punicin)  obtained  from  Punica  Granatum. 

Average  Dose:  0.25  gm.  (4  grains). 

Cusso. — U.  S. — Kousso,  also  known  as  kosso, 
koso  and  Brayera,  consists  of  the  dried  panicles  of 
the  pistillate  flowers  of  Hagenia  abyssinica.  It 
was  discovered  by  Bruce,  about  1768,  but  was  not 
generally  known  as  an  anthelmintic  until  after 
Braver,  in  1822,  published  his  observations  on  the 
use  of  the  drug  in  Constantinople.  Kousso  is  usu- 
ally administered  in  the  form  of  an  unstrained  in- 
fusion, the  object  being  to  secure  mechanical  irri- 
tation by  the  hairs  which  are  found  on  the  flowers, 
but  they  probably  play  only  a minor  part  in  the  ac- 
tion of  the  drug. 

Average  Dose:  16  gm.  (240  grains). 

Pepo. — U.  S. — Pepo,  or  pumpkin  seed,  the  ripe 
seed  of  Cucurbita  Pepo , is  usually  administered  in 
the  form  of  the  ground  seed,  deprived  of  the  hull, 
or  as  an  emulsion,  prepared  by  treating  the  ground 
seed  with  hot  water. 

Average  Dose:  30  gm.  (1  ounce). 

The  tannate  of  pelletierin,  being  slightly  sol- 
uble, is  preferred  as  a teniafuge,  but  it  is  some- 
what expensive,  and  the  decoction  of  the  root  bark 
is  therefore  frequently  directed.  It  has  been  sug- 
gested that  the  alkaloid,  being  volatile,  is  driven 
off  in  the  process  of  boiling,  but  the  loss  in  this  way 
has  proved  to  be  unimportant.  The  fresh  bark  is 
much  more  efficacious  than  that  which  has  been 
kept  for  some  time.  It  is  stated  that  the  deteriora- 
tion is  due  to  chemical  change  that  takes  place  in 
the  alkaloid. 

As  we  have  no  means  of  knowing  the  quality  of 


PARASITICIDES,  ANTIGONORRHEICS.  363 


the  bark  which  will  be  used  in  making  the  decoc- 
tion, it  is  better  to  use  the  pelletierin  tannate  or  to 
direct  the  preparation  of  the  extract1  made  ac- 
cording to  a formula  devised  by  von  Schroeder  to 
enable  one  to  get  a fairly  uniform  product  regard- 
less of  the  cpiality  of  the  bark  used. 

About  one  gram  or  less  of  the  extract,  together 
with  one  or  two  grams  of  tannin,  constitute  the 
ordinary  dose  for  tape  worm. 

Pomegranate  root  bark  contains  a large  amount 
of  tannin,  too  much,  in  fact,  considering  the 
amount  of  bark  required  to  yield  the  requisite 
amount  of  pelletierin,  hence  none  has  to  be  added 
to  the  decoction.  So  abundant  is  the  tannin  that 
it  may  cause  vomiting  and  defeat  the  purpose  for 
which  the  dose  is  given,  hence  the  extract  men- 
tioned has  a decided  advantage  over  the  decoction. 

The  following  is  the  method  of  using  pelletierin 
tannate,  the  extract  described  above,  or  the  decoc- 
tion. Beginning  in  the  evening  the  patient  takes 
a light  meal,  which  should  be  exclusively  of  carbo- 
hydrates, and  then  a laxative;  on  the  following 
morning,  while  fasting,  he  takes  0.4  to  0.5  gm.  (6 
to  8 grains)  of  pelletierin  tannate,  or  a correspond- 
ing amount  of  the  extract  or  decoction,  followed 
in  half  an  hour  or  two  hours  by  a brisk  purgative, 
such  as  castor  oil  or  syrup  of  senna. 


1.  The  ground  bark  is  exhausted  by  heating  with  water 
on  a water  bath  for  an  hour,  the  decoction  is  cooled,  milk  of 
lime  is  added  in  excess,  the  mixture  filtered,  water  being 
added  to  the  precipitate  to  wash  out  the  alkaloid,  the  wash- 
ings added  to  the  filtrate,  the  filtrate  neutralized  with  dilute 
sulphuric  acid  and  again  filtered.  It  may  be  taken  in  this 
form,  after  adding  about  a gram  of  tannin,  or  the  neutral- 
ized filtrate  may  be  evaporated  on  a water  bath  until  nearly 
solid,  and  then  extracted  with  70  per  cent,  alcohol;  this  is 
then  filtered  and  subsequently  evaporated  to  a dry  extract 
which  is  approximately  equal  to  pelletierin. 


364 


PHARMACOPEIA  AND  PHYSICIAN. 


Of  33  cases  treated  in  this  way,  the  entire  para- 
site, including  the  head,  was  removed  in  29  cases. 
Failure  in  some  cases  is  to  be  attributed  to  the 
head  being  securely  protected  by  the  folds  of  the 
mucous  membrane. 

It  is  somewhat  significant  that  the  many  for- 
mulas which  have  acquired  some  reputation  in  the 
treatment  of  tape  worm  contain  pomegranate 
bark.  The  following  taken  from  Osier  is  almost 
identical  with  a formula  which  has  been  held  as  a 
proprietary  by  a southern  firm  for  a great  many 
years,  among  whose  patrons  it  enjoys  a consider- 
able reputation : 

R.  Granati  3iv  15 1 

Pepo  *i  30 1 

Ergot®  pulveris  3i  4| 

Aqu®  bull f§x  300 1 

An  infusion  is  directed  to  be  made  [better  a decoction], 
from  which  is  formed  an  emulsion,  by  adding: 

Oleoresina  aspiaii  3i  4| 

Olei  tiglii  mii  j 12 

Acaci®  q.  s. 

The  oleoresin  of  aspidium  may  be  given  as  an 
emulsion  or  in  capsules,  or  it  may  be  combined 
with  teniafuges,  somewhat  after  the  formula  given 
above. 

Pumpkin  seeds  are  harmless  and  may  be  given 
either  in  substance  or  in  the  form  of  a decoction, 
using  an  ounce  or  more  of  the  bruised  seed. 

Of  the  other  official  substances  that  have  been 
used  to  assist  in  expelling  tenia  it  will  suffice  to 
enumerate : ether,  chloroform,  rectified  oil  of  tur- 
pentine, napthalen  and  thymol.  These  are  all 
comparatively  active  drugs  and  must,  therefore, 
be  used  with  caution. 


PARASITICIDES , ANTIGOyORRHEICS.  365 


ANTIGONORRHEICS. 

The  title  antigonorrheics  would  appear  to  sug- 
gest that  we  have  medicaments  that  have  a spe- 
cific action  on  gonorrhea,  or  the  causative  factor 
of  that  disease,  instead  of  representing,  as  it  really 
does,  a somewhat  meaningless  array  of  substances 
that  have  been  used  more  or  less  empirically  as 
remedies  for  gonorrhea. 

The  name  gonorrhea  should  properly  be  re- 
served for  the  acute,  contagious  inflammation  of 
mucous  membranes  caused  by  a specific  organism, 
the  gonococcus  of  Neisser.  In  an  even  more  re- 
stricted sense  it  is  now  frequently  applied  to  the 
specific  inflammation  caused  by  that  micro-organ- 
ism in  the  male  urethra. 

Prior  to  the  discovery  of  the ' gonococcus,  by 
IsTeisser,  in  1879.  there  was  probably  no  one  com- 
mon disease  about  which  there  existed  such  widely 
varying  theories  and  opinions,  and  certain  it  is  that 
no  known  disease  has  been  so  persistently  and  so 
widely  maltreated. 

From  the  time  of  the  early  Greeks  and  of  the 
Romans  the  treatment  of  gonorrhea  appears  to 
have  been  relegated  to  the  incompetent,  the  char- 
latan and  the  quack,  and  it  may  be  safely  asserted 
that  no  one  disease,  with  the  possible  exception  of 
syphilis,  has  been  the  direct,  or  the  indirect,  cause 
of  more  misery,  more  suffering  and  more  untimely 
deaths  because  of  this  neglect  and  maltreatment. 

Recognizing  the  seriousness  of  the  disorder  it 
would  he  futile  to  give  suggestions  for  exhaustive 
treatment,  and  practicallv  the  only  apology  that 
we  have  to  offer  for  introducing  even  a mention  of 
the  disease,  and  of  some  of  the  official  remedies 


306 


PHARMACOPEIA  AND  PHYSICIAN. 


that  may  be  of  use  in  its  treatment,  is  to  be  found 
m the  fact  that  victims  of  this  disorder  are  even 
now  subjects  for  neglect  and  malpractice.  Evi- 
dent proof  of  this  can  be  found  in  almost  any  one 
of  the  daily  papers  which  regularly  advertise  spe- 
cific cures  for  all  forms  and  kinds  of  urethral  dis- 
charges. 

The  heinousness  of  this  practice,  and  the  really 
far-reaching  and  serious  consequences  of  the  prac- 
tice in  its  ultimate  results  have  not  as  yet  been 
properly  appreciated  even  by  such  members  of  the 
medical  profession  as  should  be  more  thoroughly 
well  informed.  This  is,  in  a measure,  evidenced 
by  the  recently  published  statement,  made  by  a 
prominent  genito-urinary  specialist,  that  he  fre- 
quently uses  and  recommends  a popularly  adver- 
tised nostrum,  the  manufacturers  of  which  delib- 
erately mislead  the  layman  into  believing  that  he 
can  be  cured  in  48  hours. 

As  suggested  above,  the  treatment  of  gonorrhea 
is  not  by  any  means  the  simple  procedure  that 
might  be  wished  for  and  even  the  differentiation 
of  true  gonorrhea  from  a non-specific  inflammation 
is  one  that  requires  more  than  ordinary  skill  and 
experience,  and  should,  wherever  possible,  be  en- 
trusted to  a safe  and  conscientious  specialist,  who 
not  alone  has  the  interest  of  the  patient  in  mind, 
but  who  will  also  attempt,  so  far  as  in  him  lies,  to 
prevent  the  spread  of  the  infection  by  impressing 
on  the  patient  the  advisability  of  observing  certain 
necessary  rules  of  cleanliness,  decency  and  ab- 
stinence. 

Using  the  name,  gonorrhea,  in  its  most  re- 
stricted sense,  as  applying  only  to  the  specific 
urethritis  in  the  male,  we  may  consider  this  as  a 


PARASITICIDES,  AATIGOXORRHEICS.  367 

type,  and  recount  some  of  the  suggestions  for 
treatment  that  have  been  made  in  connection  with 
it. 

This  type  of  gonorrhea  is  said  to  be  acute,  sub- 
acute, or  chronic,  according  to  the  stage  of  the  in- 
flammatory process,  and  it  may  involve  the  an- 
terior urethra  alone  or  include,  by  continuity,  the 
posterior  urethra. 

The  generally  accepted  routine  treatment  is 
to  use  only  a mild  astringent  and  antiseptic  local 
application  for  the  first  or  acute  stage,  to  supple- 
ment this  with  the  internal  use  of  diuretics,  of  a 
terebinthinate  or  resinous  nature,  in  the  subacute 
or  secondary  stage,  and  to  use  more  active  astrin- 
gents and  antiseptics  as  local  applications  in  the 
chronic  stage  of  the  disease. 

It  will  he  noted  by  this  that  what  is  usually  re- 
ferred to  as  an  antigonorrheic  is  in  reality  but  a 
diuretic,  an  antiseptic  or  an  astringent. 

Of  the  several  official  drugs  and  preparations 
that  have  been  found  to  be  more  particularly  use- 
ful in  these  several  stages  of  the  disease,  we  may 
enumerate : 

Potassii  Perm anga nas. — U.  S. — This  is  rec- 
ommended to  he  used,  as  an  irrigation,  in  very  di- 
lute solutions  (1-2,000  to  1-6,000). 

Argenti  ISTitras. — U.  S.— This  was  formerly 
quite  popular,  in  very  dilute  solutions,  but  has 
fallen  into  disuse  and  is  now  frequently  substituted 
by  one  or  the  other  of  the  non-official  so-called  or- 
ganic silver  salts.  These  latter  preparations,  while 
unduly  numerous,  are  usually  expensive  and  the 
more  active  of  them  are  inexpressibly  filthy. 

A satisfactory  and  apparently  efficient  substi- 
tute for  the  several  silver  preparations  has  been 


368 


PHARMACOPEIA  AND  PHYSICIAN. 


found  in  silver  iodid.  Drs.  Siter  and  Uhle2  have 
reported  a series  of  eases  in  which  this  preparation 
was  used,  in  the  form  of  an  emulsion  of  the  freshly 
prepared  silver  iodid,  with  excellent  results. 

A preparation  such  as  was  used  by  Drs.  Siter 
and  Uhle  may  be  prepared  by  any  pharmacist,  as 
follows : 

Argenti  nitratis 

Potassii  iodidi,  aa  gr.  sxxiii  2 [2 

Mucilago  chondri  N.  F f.3vi  25 1 

Aquae  dest.  q.  s.  ad f.Jiii  100 [ 

M.  Sig. : Use  as  an  injection. 

The  best  method  of  preparing  a finely  divided 
precipitate  is  to  dissolve  the  potassium  iodid  in  all 
of  the  water  and  add  the  crystals  of  silver  nitrate 
gradually,  shaking  well  after  each  addition;  when 
the  silver  nitrate  is  dissolved,  add  the  mucilage 
and  shake  thoroughly  once  more. 

The  resulting  mixture  will  represent  approx- 
imately 3 per  cent,  of  silver  iodid.  The  strength 
may  be  increased  or  decreased  as  desired.  If  pre- 
pared in  this  wray,  the  weaker  mixtures  will  require 
a correspondingly  smaller  amount  of  mucilage  to 
hold  the  powder  in  suspension  and  mixtures  below 
1 per  cent,  may  be  dispensed  without  the  addition 
of  any  foreign  material. 

Of  the  drugs  that  are  frequently  used  for  inter- 
nal administration  in  the  second  or  sub-acute  stage 
of  the  disease  the  Pharmacopeia  includes,  in  the 
order  of  their  present  popularity : 

Oleum  Santali. — U.  S. — Oil  of  Santal.  or  oil 
of  sandalwood,  is  a volatile  oil  distilled  from  the 
wood  of  Santalum  album.  The  Pharmacopeia  di- 


2.  University  of  Pennsylvania  Med.  Bull.,  May,  1905. 


PARASITICIDES,  ANTIUONORRHEICS.  369 

rects  that  this  oil  contain  not  less  than  90  per  cent, 
of  santalol.  This  requirement  is  readily  met  by 
the  better  grades  of  oil  of  santal  now  on  the 
market,  so  that  there  is  little  or  no  need  to  resort 
to  proprietary  specialties  containing,  or  purporting 
to  contain,  true  oil  of  santal. 

Average  Dose:  0.5  c.c.  (8  minims). 

Copaiba. — U.  S. — Copaiba,  balsam  of  copaiba, 
as  it  is  more  popularly  called,  is  derived  from  one 
or  more  South  American  species  of  copaiba.  It 
was  introduced  into  Europe  by  the  Portuguese, 
during  the  latter  half  of  the  seventeenth  century, 
and  has  long  enjoyed  the  reputation  of  being  of 
especial  use  in  connection  with  specific  urethritis 
in  the  male. 

Average  Dose:  1 c.c.  (15  minims). 

Oleum  Copaiba. — U.  S. — Oil  of  Copaiba  is  offi- 
cially described  as  a volatile  oil  distilled  from 
copaiba. 

Average  Dose:  0.5  c.c.  (8  minims). 

OLEOBESiNiR  Cubebje. — U.  S. — Oleoresin  of  Cu- 
beb  represents  the  alcohol  soluble  portion  of  the 
dried,  unripe,  fruit  of  Piper  Cubeba. 

Average  Dose:  0.5  c.c.  (7)4  grains). 

Oleum  Cubeba. — U.  S. — Oil  of  Cubeb  is  a vol- 
atile oil  distilled  from  cubeb. 

Average  Dose:  0.5  c.c.  (8  minims). 

Of  the  more  active  astringents  that  are  used  in 
the  third,  or  chronic  stage  of  gonorrhea,  in  the 
male,  and  form  such  a prominent  part  in  the  treat- 
ment of  the  more  common  form  of  gonorrhea  in  the 
female,  we  may  enumerate: 

Zracr  Sulphas.— IT.  S. — Zinc  Sulphate. 

Zinci  Acetas. — TJ.  S.— Zinc  Acetate. 


370 


PHARMACOPEIA  AS D PHYSICIAN. 


Zinci  Chloridtjm. — U.  S. — Zinc  Chlorid. 

Zinci  Piienolsulphonas. — U.  S. — Zinc  Phe- 
nolsulphonate. 

Alumen. — U.  S. — Alum. 

Acidum  Tannicum. — U.  S. — Tannic  Acid. 

Argenti  Nitras.- — U.  S. — Silver  Nitrate. 

These  several  astringents,  with  or  without  the 
addition  of  well-known  antiseptics,  such  as  boric 
acid,  phenol,  thymol,  glycerin,  and  the  several 
combinations  or  preparations  of  them,  practically 
constitute  all  that  is  necessary  in  the  treatment 
of  the  most  persistent  of  the  chronic  forms  of  gon- 
orrhea. 


CHAPTER  XVI. 


SUBSTANCES  USED  AS  VEHICLES. 

The  great  majority  of  physicians  pay  all  too  lit- 
tle attention  to  the  art  of  rendering  their  prescrip- 
tions pleasing  alike  to  the  eye  and  to  the  palate. 
Even  in  medical  schools,  if  the  matter  is  considered 
at  all,  it  is  usually  deemed  sufficient  to  instruct  the 
student  to  give  the  mixture  a sweet  taste,  by  the 
addition  of  syrup,  or  a distinctive  aroma  by  the 
addition  of  one  or  the  other  official  medicated 
waters,  with  little  regard  for  individual  taste  or 
the  nature  of  the  mixture.  In  the  matter  of  ap- 
pearance it  is  commonly  considered  quite  sufficient 
to  avoid  the  inky  mixtures  produced  by  the  addi- 
tion of  iron  compounds  to  preparations  containing 
tannin  or  tannin-like  substances. 

Prom  the  point  of  view  of  the  patient  it  is  safe 
to  say  that  the  appearance  of  a mixture  is  often  of 
even  greater  importance  than  the  taste,  not  alone 
in  so  far  as  it  concerns  the  individual  preference 
of  the  patient,  but  even  to  the  extent  of  affecting 
the  absorption  and  the  subsequent  assimilation  of 
the  medicine,  since  we  know  that  the  digestive  se- 
cretions are  stimulated  by  tempting  looking  sub- 
stances and  are  inhibited  by  those  which  appear 
disgusting.  In  the  case  of  women  and  children 
tlie  subjects  of  flavoring  and  coloring  are  of  much 
more  importance  than  with  men.  While  the  aver- 
age physician  will,  no  doubt,  rightly  consider  that 
this  subject  does  not  deserve  very  extensive  study 
on  his  part,  he  must  admit  that  the  observance  of 


PHARMACOPEIA  AND  PHYSICIAN. 


372 


a few  easily  acquired  rules  may  be  well  worth  re- 
membering. 

Unlike  the  question  of  ready-made  formulas  for 
a great  variety  of  conditions  demanding  individ- 
ual consideration,  there  is  no  reason  why  flavoring 
and  coloring  should  not  be  reduced  to  the  very 
simplest  forms  and  used  as  a routine  whenever  the 
mixture  admits  of  it. 

When  considering  a subject  that  is  so  far-reach- 
ing and  varied  as  this  must  be,  it  will,  of  course, 
be  evident  that  the  discussion  of  the  several  mat- 
ters can  not  be  taken  up  in  detail,  but  rnugt  of  ne- 
cessity be  more  in  the  nature  of  suggestions  for  ob- 
servation and  study.  With  the  wealth  of  material 
that  is  available,  by  the  use  of  the  official  aro- 
matics and  diluents,  it  should  be  a comparatively 
easy  matter  for  a plrysician  to  become  thoroughly 
familiar  with  the  properties  and  possible  uses  of  at 
least  several  of  these  preparations  and  by  judicious 
combination  to  produce  not  alone  a variety  of  mix- 
tures, but,  also,  to  impart  to  them  an  individual- 
ity in  which  he  may  well  take  pride. 

Many  of  the  comparatively  tasteless  substances 
require  but  the  addition  of  some  mildly  aromatic 
solvent  or  diluent,  such  as  the  aromatic  medicated 
waters.  Substances  that  are  more  acrid,  bitter  or 
saline  in  taste  may  be  masked  by  the  addition  of  a 
small  amount  of  syrup  to  the  aromatic,  or  by  the 
addition  of  a preparation  containing  glvcyrrhizin, 
like  the  now  official  elixir  adjuvans.  Nauseous 
bitters  are  best  masked  with  strong  aromatics  and 
syrup.  The  simple  but  persistent  bitters,  such  as 
quinin  and  strychnin,  are  agreeably  modified  by 
such  an  aromatic  as  tincture  of  sweet  orange  peel, 
wine  and  sufficient  syrup  to  suggest  sweetness.  As 


SUBSTANCES  USED  AS  VEHICLES. 


373 


an  example  of  such,  a preparation  we  may  mention 
the  bitter  wine  of  iron,  which  will  be  appreciated 
if  one  will  but  taste  this  really  elegant  prepara- 
tion. 

MEDICATED  WATERS. 

The  most  simple,  and,  therefore,  the  most  read- 
ily available  of  the  official  diluents  or  vehicles  are 
the  aromatic,  medicated  waters.  They  are  partic- 
ularly well  adapted  for  dissolving  such  compara- 
tively mild  tasting  substances  as  potassium  citrate, 
sodium  benzoate,  sodium  salicylate,  morphin  sul- 
phate and  antipyrin. 

One  of  the  most  pleasant  of  these  preparations 
is : 

Aqua  Amygdala  Amar^e. — U.  S. — Bitter  al- 
mond water.  This  contains  about  0.1  per  cent,  of 
oil  of  bitter  almond,  and  appears  to  be  particu- 
larly adapted  for  use  with  sedative  expectorants 
such  as  codein  sulphate. 

Average  Dose:  4 c.c.  (Ifluidram). 

The  following  are  particularly  well  adapted  for 
use  with  children : 

Aqua  Anisi. — IT.  S. — Anise  Water,  and 

Aqua  Fceniculi. — IT.  S. — Fennel  Water.  They 
contain  about  0.2  per  cent,  of  the  respective  vola- 
tile oils  and  have  long  been  popular  as  correctives 
or  diluents  for  medicines  such  as  fever  mixtures 
and  mild  anti-diarrhea  mixtures,  designed  pri- 
marily for  children. 

Average  Dose  of  either  of  the  above:  16  c.c.  (4 
fluidrams) . 

Another  aromatic  water  that  has  met  with  con- 
siderable use  is : 

Aqua  Cienamomi. — IT.  S. — Cinnamon  Water 
also  represents  approximately  0.2  per  cent,  of  the 


374 


PHARMACOPEIA  AND  PHYSICIAN. 


volatile  oil  and,  as  a flavor,  is  sometimes  pre- 
ferred. 

Average  Dose:  16  c.c.  (4  fluidrams). 

By  far  the  most  popular  of  the  aromatic  waters 
are: 

Aquje  Menth2E  Piperita. — U.  S. — Pepper- 
mint Water,  and 

Aquje  Menthje  Yiridis. — U.  S. — Spearmint 
Water.  These,  like  the  preceding,  are  simple  solu- 
tions of  volatile  oils  in  water  and  represent  ap- 
proximately 0.2  per  cent,  of  their  respective  vola- 
tile oils. 

Average  Dose  of  either : 16  c.c.  (4  fluidrams) . 

Peppermint  water,  or  spearmint  water,  is  partic- 
ularly well  adapted  for  use  with  the  mild  alkalies, 
such  as  potassium  bicarbonate  or  sodium  bicarbon- 
ate, or  mixtures  of  these  with  other  soluble  salts. 

The  efficiency  of  solutions  of  the  alkaline  bicar- 
bonates may  be  usually  enhanced  by  the  addition 
of  a simple  bitter,  such  as  tincture  of  nux  vomica 
or  tincture  of  calumba. 

Simple  solutions,  even  such  as  contain  a small 
addition  of  a bitter  substance,  should  be  directed 
to  be  filtered,  as  this  adds  materially  to  the  appear- 
ance of  the  mixture  and  thus  enhances  its  palat- 
ability  and  efficiency. 

When  a vehicle  having  more  pronounced  char- 
acteristics is  desired  the  official  aromatic  elixir  will 
probably  serve  to  meet  more  possible  indications 
than  any  one  other  preparation.  It  may  itself  be 
varied  by  the  addition  of  the  fluid  extract  of  gly- 
cyrrhiza,  as  in  the  official  elixir  adjuvans.  or  by  the 
addition  of  one  of  the  official  spirits,  syrups,  aro- 
matic tinctures  or  simple  wines. 

Aromatic  elixir  is  particularly  useful  in  connec- 


SUBSTANCES  USED  AS  VEHICLES. 


375 


tion  with  the  scale  salts  of  iron,  the  bitter  alka- 
loids, and  also  with  the  soluble  iodids  and  bromids ; 
with  the  latter,  however,  the  stimulating  effect  of 
the  contained  alcohol  should  not  be  lost  sight  of. 

The  following  are  among  the  preparations  that 
will  be  found  to  be  of  use  in  connection  with  the 
possible  modifications  of  the  simple  elixir  or  other 
desirable  vehicles : 

Elixir  Aromatxcum. — U.  S. — Aromatic  Elixir 
is  practically  a.  solution  of  a mixture  of  the  oils  of 
orange  peel,  lemon,  coriander  and  anise  in  25  per 
cent,  alcohol,  containing  about  38  per  cent,  of 
syrup.  The  resulting  preparation  is  not  alone 
strongly  aromatic,  but  is  also  sufficiently  dense  to 
hold  finely  divided  substances  well  in  suspension, 
while  the  alcohol  content  is  not  sufficient  to  be  ob- 
jectionable in  the  ordinary  doses. 

Elixir  Ad ju vans. — U.  S. — Adjuvant  elixir. 
This  is  a simple  mixture  of  12  parts  of  fluidextract 
of  glycyrrhiza  with  88  parts  of  aromatic  elixir, 
and  is  particularly  well  adapted  for  masking  acrid, 
bitter  or  saline  materials.  The  contained  glycyr- 
rhizin  not  being  soluble  in  acid  solutions,  the  prep- 
aration is  obviously  not  suited  for  use  with  diluted 
acids  or  acid  salts. 

The  official  spirits  that  may  be  used  as  additions 
to  aromatic  elixirs  or  as  correctives  to  other  alco- 
holic or  hydro-alcoholic  solutions  are : 

Spiritits  Anisi.— U.  S.- — Spirit  of  Anise  con- 
tains 10  per  cent,  of  oil  of  anise  in  alcohol. 

Average  Dose:  4 c.c  .(1  fluidram). 

Spiritus  Amtgdalie  Amarje. — U.  S. — Spirit  of 
Bitter  Almonds  contains  10  per  cent,  of  oil  of  bitter 
almond  in  alcohol,  and  is  the  most  potent  of  the 
official  spirits.  It  is  markedly  aromatic  and  a very 


370 


PHARMACOPEIA  AND  PHYSICIAN. 


small  quantity  usually  suffices  to  impart  a dis- 
tinctive almond  odor  and  taste. 

Average  Dose:  0.5  c.c.  (8  minims). 

Spiritus  Cinnamomi. — U.  S. — Spirit  of  Cinna- 
mon contains  10  per  cent,  of  oil  of  cinnamon. 

Average  Dose:  2 c.c.  (30  minims). 

Spiritus  Gaultheri^. — U.  S. — Spirit  of  Gaul- 
tlieria  is  a useful  preparation  for  cases  in  which  the 
patient  appears  to  have  a predilection  for  teaberry 
or  wintergreen.  This  preparation  imparts  a dis- 
tinctive odor  and  taste  and  should  be  used  with 
caution,  as  it  appears  to  be  objectionable  to  many 
people.  It  represents  10  per  cent,  of  oil  of  gaul- 
theria. 

Average  Dose:  2 c.c.  (30  minims). 

Spiritus  Mentha  Piperita. — U.  S. — Spirit 
of  Peppermint  and 

Spiritus  Mentha  Yiridis. — U.  S. — Spirit  of 
Spearmint,  in  addition  to  containing  10  per  cent, 
of  the  respective  volatile  oils  also  represent  the  al- 
cohol-soluble portion  of  1 per  cent,  of  the  respective 
dry  crude  drug,  which  imparts  to  them  a dis- 
tinctive yellowish-green  color. 

Average  Dose  (either)  : 2 c.c.  (30  minims). 

The  aromatic  tinctures  that  are  particularly 
useful  for  adding  distinctive  characteristics  to 
liquid  mixtures  are : 

Tinctura  Aurantii  Dulcis. — IT.  S. — Tincture 
of  Sweet  Orange  Peel.  This  preparation  is  directed 
to  be  made  from  the  fresh  peel  and  represents  ap- 
proximately 50  per  cent,  of  the  crude  drug.  It  is 
a delicate  but  efficient  aromatic  and  is  useful  in 
connection  with  any  of  the  hydro-alcoholic  mix- 
tures. 

Average  Dose:  4 c.c.  (1  fluidram). 


SUBSTANCES  USED  AS  VEHICLES. 


377 


Tinctura  Cardamomi. — U.  S. — Tincture  of 
Cardamom  represents  20  per  cent,  of  cardamom  in 
diluted  alcohol. 

Average  Dose:  4 c.c.  (1  fluidram). 

Tinctura  Cardamomi  Composita. — U.  S. — 
Compound  Tincture  of  Cardamom  represents  2.5 
parts  each  of  cardamom  and  Saigon  cinnamon,  1 
part  of  caraway,  0.5  parts  of  cochineal  and  5 parts 
of  glycerin  in  sufficient  diluted  alcohol  to  make 
100  parts. 

Average  Dose:  4 c.c.  (1  fluidram). 

Tinctura  Lavandula  Composita. — IT.  S. — 
Compound  Tincture  of  Lavender  consists  of  a mix- 
ture of  0.8  parts  of  oil  of  lavender  flowers  and  0.2 
parts  of  oil  of  rosemary  in  75  per  cent,  alcohol, 
which  is  used  to  exhaust  2 parts  of  Saigon  cinna- 
mon, 0.5  part  of  cloves,  1 part  of  nutmeg  and  1 
part  of  red  saunders. 

The  possible  uses  of  this  preparation  are  prob- 
ably best  illustrated  by  the  official  solution  of 
potassium  arsenite,  which  is  flavored  and  at  the 
same  time  colored  by  the  use  of  3 per  cent,  of  this 
tincture. 

Average  Dose:  2 c.c.  (30  minims). 

Tinctura  Vaxillae. — IT.  S. — Tincture  of  Ya- 
nilla  represents  10  per  cent,  of  vanilla  in  65  per 
cent,  alcohol  and  is  sweetened  by  the  addition  of 
20  per  cent.,  by  weight,  of  sugar. 

The  official  simple  wines  are : 

Yinum  Album. — IT.  S. — White  Wine.  This  is 
an  alcoholic  liquid,  made  by  fermenting  the  juice 
of  fresh  grapes,  the  fruit  of  Vitis  vinifera,  and 
usually  contains  about  10  per  cent,  of  alcohol. 

White  wine  constitutes  an  excellent  vehicle  for  a 
number  of  acrid  or  bitter  substances,  and  is  par- 


378 


PHARMACOPEIA  AND  PHYSICIAN. 


ticularly  useful  as  an  addition  to  the  official  aro- 
matic elixir.  If  from  10  to  25  per  cent,  of  white 
wine  be  added  to  aromatic  elixir  it  will  impart  to 
the  latter  a distinctive  and  generally  agreeable 
odor  and  taste. 

Vinum  Rubrum. — TJ.  S. — Red  Wine  is  an  alco- 
holic liquid  that  is  made  by  fermenting  the  juice 
of  fresh,  red-colored  grapes,  the  fruit  of  Vitis 
vinifera,  in  the  presence  of  their  skins,  and  sub- 
jected to  the  usual  cellar  treatment  for  fining  and 
aging. 

The  official  syrups  that  are  generally  well  known 
or  widely  used  as  diluents,  correctives  or  vehicles 
are : 

Syrupus  Acidi  Citrici. — U.  S. — Syrup  of  Cit- 
ric Acid.  This  is  a slightly  acid  syrup,  flavored 
with  tincture  of  fresh  lemon  peel,  and  is  useful  in 
connection  with  the  aqueous  solutions  of  the  alka- 
line salts  of  organic  acids,  such  as  potassium 
citrate. 

Syrupus  Aurantii. — U.  S. — Syrup  of  Orange 
also  contains  a trace  of  citric  acid  and  has  a pleas- 
ant acidulous  taste.  It  is  frequently  used  in  place 
of  the  syrup  of  citric  acid  and  is  preferred  by 
many. 

Syrupus  Pruni  Virginian^.- — -TJ.  S. — Syrup 
of  Wild  Cherry,  while  it  represents  the  aqueous  ex- 
tractive of  15  parts  of  wild  cherry,  is  most  largely 
used  as  a pleasant  vehicle  or  as  an  addition  to  other 
diluents,  particularly  in  connection  with  expec- 
torants. 

Average  Dose:  4 c.c.  (1  fluidram). 

Syrupus  Tolutanus. — U.  S. — Syrup  of  Tolu 
represents  the  water-soluble  portion  of  5 per  cent, 
of  tincture  of  tolu,  and.  like  the  preceding,  is  fre- 


SUBSTANCES  USED  AS  VEHICLES. 


379 


quently  used  as  a corrective  to  mixtures  that  are 
designed  for  use  as  expectorants. 

Average  Dose:  16  c.c.  (4  fluidrams). 

Syrupus  Sarsaparilla  Compositus. — U.  S. — 
Compound  Syrup  of  Sarsaparilla  contains  fluidex- 
tract  of  sarsaparilla,  fluidextract  of  glycyrrhiza 
and  fluidextract  of  senna,  and  is  flavored  with  a 
mixture  of  the  volatile  oils  of  sassafras,  anise  and 
gaultheria. 

This  preparation  constitutes  an  interesting  re- 
minder of  the  widespread  use  of  sarsaparilla  as  a 
universal  panacea  almost  a century  ago,  but  it  is 
now  seldom  used  for  any  other  purpose  than  as  a 
vehicle.  It  is  particularly  useful  for  such  acrid 
drugs  as  the  soluble  mercurial  salts  and  the  iodids 
and  bromids. 

Average  Dose:  16  c.c.  (4  fluidrams). 

For  use  with  immiscible  liquids,  for  making 
emulsions  and  for  suspending  insoluble  powders 
in  aqueous  solutions  it  is  an  almost  universal  prac- 
tice to  use  the  official  mucilage  or  gums. 

Mucilago  Acacia. — U.  S. — Mucilage  of  Aca- 
cia, containing  34  per  cent,  by  weight  of  acacia, 
33  per  cent,  of  limewater  and  33  per  cent,  of  dis- 
tilled water,  is  probably  the  best  known  of  these 
several  preparations.  It  has  a very  wide  field  of 
usefulness,  but  as  acacia  is  precipitated  by  alcohol 
is  not  useful  in  connection  with  strongly  alcoholic 
liquids.  The  presence  of  limewater  may  prove  to 
be  a disturbing  factor  in  connection  with  solutions 
of  the  alkaloids,  and  here  the  mucilage  may  readily 
be  substituted  by  the  syrup. 

Syrupus  Acacia. — TJ.  S. — This  represents  10 
parts  of  acacia  in  a moderately  heavy  syrup. 

Mucilago  Tragacaytha. — U.  S. — Mucilage  of 


;80 


PHARMACOPEIA  ART)  PHYSICIAN. 


Tragacanth  contains  6 parts  of  tragacanth,  18  parts 
of  glycerin  and  sufficient  water  to  make  100  parts. 
This  preparation  is  particularly  useful  in  connec- 
tion with  alcoholic  liquids  and  is  very  widely  used 
for  suspending  the  content  of  resinous  tinctures  in 
aqueous  mixtures. 

Another  preparation  that  is  quite  extensively 
used  to  mask  acrid,  bitter  or  otherwise  disagree- 
able drugs  is  the  recently  admitted 

Extractum  Marti. — TJ.  S. — Extract  of  Malt 
occurs  as  a semi-solid  extract,  having  the  consis- 
tency of  thick  honey,  and  is  itself  considered  to  be 
nutritive,  tonic  and  laxative.  It  has  been  used 
quite  extensively,  particularly  in  connection  with 
several  widely  used  proprietary  preparations,  as  a 
vehicle  for  cod-liver  oil,  cascara  sagrada  and  the 
bitter  alkaloids  like  quinin  and  strychnin. 

Average  Dose:  16  c.c.  (4  fluidrams). 

SUGGESTIVE  COLORING. 

The  subject  of  coloring  is  a much  simpler  one 
than  is  that  of  flavoring,  but  it  is  of  almost  equal 
importance,  if  we  are  to  judge  by  the  practices  that 
have  been  followed  by  manufacturers  of  elegant 
proprietaries  for  upward  of  a quarter  of  a cen- 
tury. 

Coloring  agents  are  primarily  divided  into  such 
as  are  useful  with  alkaline  and  neutral  substances 
and  such  as  are  useful  with  dilute  solutions  of  the 
official  acids  and  acid  salts. 

For  those  of  the  first  class,  preparations  con- 
taining carmin  or  cochineal,  for  red,  and  glycyr- 
rhizin  for  brown  are  readily  available.  For  the  so- 
lutions of  acids  and  acid  salts,  however,  neither  of 
these  substances  would  answer,  as  they  are  both 


SUBSTANCES  USED  AS  VEHICLES. 


381 


precipitated  by  acids,  and  we  have  recourse,  there- 
fore, to  cudbear  for  the  red  and  caramel  for  the 
brown. 

Taking  the  official  aromatic  elixir  as  a type,  this 
may  be  colored  a bright  red  by  the  addition  of 
from  10  to  20  per  cent,  of  the  compound  tincture 
of  cardamom,  containing  cochineal,  or  it  may  be 
given  an  equally  bright  red  color  by  the  addition 
of  1 per  cent,  of  the  Tincture  of  Cudbear  of  the 
National  Formulary.  Cudbear  is  the  source  of 
the  bright  red  color  that  is  so  common  in  pro- 
prietary preparations,  and  as  cudbear  itself  has  no 
known  medicinal  properties,  apart  from  the  pleas- 
ing suggestiveness  of  the  resulting  preparation,  we 
must  naturally  conclude  that  the  manufacturers  of 
proprietary  preparations  have  succeeded  in  im- 
pressing not  alone  the  patient,  but,  in  many  cases 
at  least,  the  physician  also,  by  the  judicious  use  of 
pretty  colors. 

The  use  of  caramel  (burnt  sugar),  is  too  well 
known  to  need  further  comment,  apart  from  the 
fact  that  the  National  Formulary  contains  a for- 
mula for  a compound  tincture  of  cudbear  which 
contains  10  per  cent,  of  caramel  and  will  be  found 
useful  when  a brownish-red  preparation  is  de- 
sired. 

A very  pleasing  golden-yellow  mixture  that  ap- 
pears to  be  fairly  stable  with  either  acid  or  alka- 
line solutions  may  be  obtained  by  adding  1 per 
cent,  or  even  less  of  the  now  official  tincture  of 
hydrastis.  This  preparation,  though  made  with  65 
per  cent,  alcohol,  mixes  readily  with  the  official 
elixir,  but  precipitates  slightly  when  added  to 
aqueous  solutions,  and  they  should,  therefore,  be 
directed  to  be  filtered  before  being  dispensed. 


CHAPTER  XVII. 


THE  NATIONAL  FORMULARY  AND  THE 
USE  OP  EXTRAPHARMA  COPET  AT; 
SUBSTANCES. 

An  extended  review  of  the  application  and  the 
uses  of  pharmacopeial  articles  would  be  incomplete 
without  some  discussion  of  permissible  extra- 
pharmacopeial  substances,  and  at  least  a passing 
reference  to  that  most  legitimate  of  all  sources 
of  unofficial  preparations — the  National  Formu- 
lary. 

To  appreciate  more  thoroughly  the  rise  and  the 
need  of  authoritative  works  of  reference  on  extra- 
pharmacopeial  preparations  we  must  remember 
that  the  remedies  which  have  been,  and  which 
properly  should  be,  included  in  the  National  Phar- 
macopeia constitute  but  a very  limited  portion  of 
the  possible  resources  of  medical  men  of  the  pres- 
ent day,  and  are  practically  confined  to  those  well- 
known  drugs  and  preparations  that  are  generally 
used  in  all  parts  of  the  country,  and  may,  there- 
fore, be  considered  as  being  thoroughly  well  estab- 
lished. 

Despite  the  fact  that  a medical  practitioner  who 
is  thoroughly  well  acquainted  with  the  established, 
or  official,  materia  medica  would  be  in  a position 
to  meet  all  possible  physiologic  as  well  as  thera- 
peutic indications,  so  far  as  known,  there  is  no 
gainsaying  the  fact,  that  there  can  be  no  progress 
without  experimentation,  and  experimentation  in 


THE  NATIONAL  FORMULARY. 


383 


the  field  of  materia  medica  implies  the  use  of  new 
remedies  in  comparatively  well  understood  patho- 
logic conditions,  or  the  use  of  well-known  or  other- 
wise well  established  remedies  in  conditions  that 
are  less  well  understood. 

With  the  gradual  increase  of  our  knowledge  of 
the  physiologic  action  and  the  limitations  of  medic- 
inal substances  there  is  a correspondingly  decreas- 
ing need  for  the  empiric  use  or  the  haphazard  ex- 
perimentation with  drugs  and  other  therapeutically 
active  substances.  On  the  other  hand,  it  must 
also  be  remembered  that  physiologic  indications, 
as  we  understand  or  interpret  them,  at  the  present 
time,  do  not  fully  represent  the  therapeutic  uses 
and  the  limitations  of  medicinal  substances  in  the 
diseased  human  organism. 

Bearing  in  mind,  then,  the  imperfect  state  of 
our  knowledge  concerning  the  normal  functions  of 
the  several  organs  of  the  human  body,  the  possible 
irregularities  or  diseases  and  the  treatment  of  these 
irregularities  with  the  more  or  less  imperfect  mate- 
rials at  our  command,  and  it  may  be  added  also, 
the  multifarious  demands  on  the  general  prac- 
titioner in  the  daily  routine  of  his  practice,  no 
reasonable  individual  can  possibly  object  to  the  use 
of  safe  and  well-understood  substances  that  have 
been  demonstrated  to  possess  medicinal  virtues, 
though  they  have  not  been  admitted  to  the  roll  of 
more  thoroughly  established  articles  represented  by 
the  Pharmacopeia.  Here,  however,  differences  of 
opinion  will  arise  as  to  what  constitutes  a safe  and 
well-understood  medicinal  substance.  Since  it  is 
impossible  for  a medicinally  active  substance  to  be 
potent  only  for  good  and  to  be  innocuous  as  far  as 
deleterious  results  are  concerned,  we  must  modify 


384 


PHARMACOPEIA  AX D PHiSICIAX. 


the  first  part  of  our  requirement  and  limit  it  to 
articles,  the  action  and  uses  of  which  have  been 
established. 

While  this  requirement  would  undoubtedly  con- 
stitute a reasonable  and  rational  safeguard,  it  will 
be  difficult  to  limit  ourselves  to  it  too  strictly.  The 
reasons  for  this  will  become  more  apparent  when 
we  remember  that  such  a comparatively  simple  drug 
as  squill,  which  has  been  in  continuous  use  for 
hundreds  of  years,  even  now  is  not  well  under- 
stood, either  chemically  or  physiologically,  and  that 
digitalis,  a drug  that  has  been  studied  by  the  lead- 
ing men  in  the  medical  profession  almost  continu- 
ously for  half  a century,  still  presents  problems 
to  the  clinician  as  well  as  to  the  pharmacologist, 
that  may  require  years,  if  not  decades,  of  added 
work  to  solve. 

When  we  realize  how  little  positive  knowledge  we 
possess  of  the  action,  uses  and  limitations  of  drugs 
and  medicinal  preparations,  that  have  been  in  con- 
tinued use  for  a long  period  of  time,  we  begin  to 
suspect  that  many,  if  not  all,  of  the  positive  claims 
that  are  now  being  made  in  connection  with  new 
drugs  and  complicated  synthetic  chemicals,  may, 
after  more  careful  observations,  be  found  to  be  far 
from  correct. 

The  secondary  or  so-called  untoward  effects  of 
many  drugs  and  preparations  are  so  insidious  that 
much  harm  may  be  done  before  it  becomes  known 
that  such  untoward  effects  should  be  looked  for. 

As  an  illustration  of  the  harm  that  may  result 
from  the  indiscriminate  or  too  liberal  use  of  new 
remedies,  even  of  the  comparatively  few  that  ap- 
pear to  have  established  themselves  as  permanent 
additions  to  our  materia  mediea,  attention  is 


THE  NATIONAL  FORMULARY. 


385 


directed  to  the  harm  that  has  been  done,  directly, 
as  well  as  indirectly,  by  acetanilid. 

For  over  twenty  years  acetanilid  was  freely 
used,  either  in  substance  or  in  the  form  of  various 
mixtures  that  are  even  now  being  marketed  as  pro- 
prietary nostrums.  All  of  these  preparations  were 
presumed  to  be  potent  factors  for  good  and  innocu- 
ous so  far  as  any  deleterious  results  were  con- 
cerned. 

Despite  the  fact  that  many  physicians  suspected 
that  acetanilid  was  directly  responsible  for  a long 
train  of  little-understood  symptoms  that  occur  as 
secondary  complications  from  its  excessive  or  con- 
tinued use,  it  is  fair  to  presume  that  but  few  were 
prepared  to  assert  that  acetanilid  was  directly  to 
blame  for  the  many  really  serious  complications, 
and  even  deaths,  that  have  been  reported  during  the 
past  year  or  two. 

Of  the  other  new  remedies  that  are  widely  used, 
largely  because  manufacturers  have  asserted  that 
they  are  free  from  possible  injurious  effects,  we 
may  refer  to  the  widely  used  coal-tar  hypnotics. 
Drugs  of  this  kind  are  freely  used  by  lay  persons 
of  all  degrees  of  intelligence  in  the  mistaken  belief 
that  they  are  safe  and  harmless.  It  is  known, 
however,  that  all  hypnotics  conduce  to  the  con- 
tinued use  of  sedative  drugs  and  many  are  the 
direct  cause  of  physical,  mental  and  moral  de- 
generacy. In  addition  to  the  possible  harm  that 
may  result  from  the  continued  use  of  drugs  of  this 
type,  it  lias  been  repeatedly  shown  that  the  coal-tar 
hypnotics,  despite  their  reputed  harmlessness,  have 
been  the  direct  as  well  as  the  indirect  cause,  in 
many  instances,  of  death. 

One  more  illustration  of  our  overzealousness  to 


380 


PHARMACOPEIA  AND  PHYSICIAN. 


believe  the  assertions  of  manufacturers,  to  our 
own  discredit : A few  years  ago  diacetylmorphin, 

better  known  by  the  proprietary  name  heroin,  was 
being  exploited  as  a perfectly  safe  and  reliable  sub- 
stitute for  morphin.  Heroin  was  reputed  to  pos- 
sess all  of  the  good  properties  of  morphin  without 
any  of  its  faults,  and  it  was  even  heralded  as  a 
positive  cure  for  the  morphin  habit.  According  to 
more  recent  reports,  however,  heroin  is  not  devoid 
of  the  danger  of  inducing  drug  addiction,  and, 
what  is  even  worse,  is  latterly  reported  to  conduce 
to  a habit  that  is  as  persistent  as  the  morphin 
habit  itself. 

The  experience  that  we  have  obtained  from  these 
now  better  imderstood  and  valuable  remedies 

• 

should  be  sufficient  to  make  us  more  cautious  in 
the  use  of  new  drugs  and  chemicals  that  are  ex- 
ploited by  those  whose  only  interest  in  them 
is  purely  commercial.  The  evident  need  in 
connection  with  the  introduction  of  new 
drugs  and  chemicals  is  a less  restricted  dis- 
semination of  information  bearing  on  their  un- 
toward results  and  shortcomings,  so  that  unneces- 
sary repetition  of  disappointing  and  at  times  harm- 
ful experiences  may  be  avoided.  How  imperative 
is  this  need  for  greater  publicity  in  connection 
with  newer  remedies  is  well  illustrated  by  the  vol- 
umes on  new  remedies  that  have  been  published 
during  the  past  two  decades.  If  we  review  one  of 
the  volumes  that  has  been  published  ten  or  more 
years  ago  we  find  hundreds  of  highly  recommended 
substances  that  are  now  out  of  use,  despite  the  fact 
that  no  derogatory  report  can  be  found  in  the  pages 
of  current  medical  journals.  That  some  really 
vital  reason  for  the  disappearance  of  these  numer- 


THE  NATIONAL  FORMULARY. 


387 


ous  substances  must  have  existed  is  evident,  but 
the  present  method  of  eliminating  such  new  reme- 
dies is  objectionable  as  not  only  slow  but  full  of 
possible  harm  to  our  patients. 

The  publication  of  the  proposed  Handbook  on 
Hew  and  Non-official  Kemedies  by  the  American 
Medical  Association,  through  its  Council  on  Phar- 
macy and  Chemistry,  will  no  doubt  contribute 
materially  to  bring  about  a better  understanding 
and  a more  rapid  elimination  of  the  numerous 
remedies  of  uncertain  value  and  composition  that 
are  now  being  offered.  In  this  connection  it  is 
fair  to  suppose  that  manufacturers,  who  will  be 
given  the  advantage  of  added  publicity  for  the  de- 
sirable properties  of  their  several  preparations,  will 
not  oppose  free  and  impartial  discussion  of  the 
shortcomings  and  the  limitations  of  these  prepa- 
rations. 

Drugs  and  chemicals  of  original  and  meritorious 
character  constitute  but  one  of  several  classes  of 
extrapharmacopeial  articles  that  merit  careful  con- 
sideration. A much  larger  class,  and  one  whose 
use  has  been  accompanied  by  even  greater  abuses, 
consists  of  mixtures  of  more  or  less  well-known  sub- 
stances whose  preparation  requires  but  ordinary 
pharmaceutical  skill  and  which  may  be  prepared 
quite  as  satisfactorily  by  the  retail  pharmacist  as 
by  the  large  manufacturer.  The  allegations  that 
are  usually  made  for  mixtures  of  this  kind,  when 
exploited  as  proprietary  products,  are  frequently 
misleading,  due  to  the  direct  or  implied  mis- 
statements that  are  made  in  connection  with  the 
advertising  matter  put  out  by  their  manufacturers. 

Another  cause  for  the  present  situation  is  the 
quite  natural  assumption  of  these  lay  manufac- 


388 


PHARMACOPEIA  AND  PHYSICIAN. 


turers  that  the  simple  admixture  of  two  or  more 
well-known  substances  constitutes  a discovery,  and 
that  the  making  of  such  a “discovery,”  or  perhaps 
only  the  rediscovery  of  such  a discover}’,  should 
entitle  the  individual  making  it  to  certain  perma- 
nent privileges  in  the  form  of  absolute  control  of 
the  particular  combination,  and  should  further  per- 
mit him  to  exact  such  emoluments  or  profits  as 
he  sees  fit. 

Quite  apart  from  the  absurdity  of  the  claim  of 
proprietorship  in  each  mixture  is  the  assumption 
that  because  such  a mixture  is  made  by  one  certain 
individual  or  firm  it  must  be  invested  with  cer- 
tain new  or  extraordinary  properties  and  will, 
therefore,  be  superior,  and  will  meet  a variety 
of  indications  foreign,  to  the  same  mixture  when 
compounded  by  some  other  presumably  less  skillful 
persons.  How  far-reaching  the  further  unre- 
stricted progress  of  this  species  of  proprietorship 
might  become  is  indicated  by  the  fact  that  at  the 
present  time  there  are  over  30,000  distinct  prepa- 
rations, and  that  the  articles  that  are  official  in  the 
Pharmacopeia  of  the  United  States  alone  would 
offer  further  possibilities  of  untold  thousands  of 
similar  “original”  mixtures. 

While  it  is  reasonable  to  suppose  that  one  manu- 
facturer may  possibly  acquire  a certain  amount 
of  skill  in  the  combination  of  certain  well-known 
ingredients,  or  may  be  in  position  to  exercise  greater 
care  in  the  selection  of  the  constituent  materials, 
these  assertions  and  claims  are  foreign  to  the  ques- 
tion of  proprietorship  and  may  be  conceded  when 
such  facts  are  actually  demonstrated. 

Among  the  factors  that  have  contributed  to  a 
more  reasonable  view  of  proprietorship  in  medicinal 


THE  NATIONAL  FORMULARY. 


389 


compounds  are  the  National  Formulary  and  other 
books  of  its  particular  type.  It  is  more  particularly 
due  to  the  general  recognition  that  has  been  ac- 
corded the  National  Formulary  as  an  authoritative 
standard  for  unofficial  preparations  that  we  at  the 
present  time  are  better  able  to  differentiate  between 
the  reasonable  announcements  that  are  made  by 
reputable  manufacturers  and  the  bold  claims  of 
absolute  proprietorship,  based  on  pretended  priority 
of  discovery,  made  by  manufacturers  of  question- 
able nostrums. 

That  the  use  of  well-established  formulae,  apart 
from  those  contained  in  the  Pharmacopeia,  is  not 
a recent  one  is  well  illustrated  by  the  natural  se- 
quence and  the  evolution  of  well-known  formularies 
in  this  country. 

The  earliest  of  these,  “Formulae  Selectae,  or  a 
Collection  of  Prescriptions  of  Eminent  Physi- 
cians,” was  published  by  P.  Donaldson,  New  York, 
in  1818,  two  years  before  the  first  edition  of  the 
Pharmacopeia  of  the  United  States  was  published 
in  Boston. 

From  the  preface  of  this  early  formulary  it  ap- 
pears that  its  publisher  fully  appreciated  the  limi- 
tations and  the  needs  of  popular  formulae  and  the 
contents  of  the 'book  shows  that  not  a few  of  the 
problems  that  confronted  the  medical  practitioners 
of  that  early  date  are  still  with  us,  though  changed 
somewhat  in  character. 

Tli is  formulary  is  particularly  interesting  in 
that  it  gives  us  a fair  representation  of  the  develop- 
ment of  the  science  of  medicine  at  that  time.  Tn 
connection  with  the  claims  made  for  proprietor- 
ship in  medicinal  compounds  it  may  be  interesting 
to  mention  that  among  the  numerous  formulae  for 


390 


PHARMACOPEIA  AND  PHYSICIAN. 


“patent  medicines/’  mostly  of  English  and  Dutch 
origin,  mentioned  in  this  book,  there  are  several 
of  the  then  popular  nostrums  made  in  America. 
Under  tire  title  “Connecticut  Pill”  we  find  a 
formula  that  “is  believed  to  be  the  composition  of 
the  celebrated  Lee’s  pill.”  This,  it  may  be  added, 
is  reputed  to  have  been  the  first  medicine  patented 
in  the  United  States,  and  certainly  was  the  direct 
cause  of  no  inconsiderable  amount  of  friction  in 
the  Connecticut  State  Medical  Society. 

One  quotation  from  the  p ref  ace  illustrates  the 
keen  appreciation  that  its  author  had  of  the  needs 
and  the  limitations  of  the  several  authoritative 
works  of  reference.  He  says : “A  recipe  may  have 
reputation  and  deserved  celebrity  and  yet  not  find 
a place  among  official  preparations,  which  should 
be  few  in  number  and  retrenched  of  everything 
that  could  be  deemed  superfluous.” 

The  next  formulary,  in  point  of  time,  was  that 
usually  referred  to  as  “Ellis’  Medical  Formulary.” 
This  book  was  originally  compiled  by  Benjamin 
Ellis,  a young  physician  of  Philadelphia,  who  had 
attained  some  local  celebrity  as  the  professor  of 
materia  medica  in  the  Philadelphia  College  of 
Pharmacy. 

The  first  edition  of  this  book  appears  to  have 
been  published  in  1828;  it  was  followed  by  a sec- 
ond in  1829  and  a third  edition  in  1831.  The 
continued  popularity  of  this  formulary,  even  after 
its  }7oung  compiler’s  early  death  in  1831,  led  to 
its  repeated  revision  and  republication.  Several 
of  these  editions,  including  the  eighth  and  ninth, 
were  edited  by  Dr.  S.  G.  Morton.  The  tenth  and 
eleventh  editions,  appearing  in  1854  and  1864  re- 
spectivelv.  were  edited  by  Dr.  E.  P.  Thomas,  and 


THE  NATIONAL  FORMULARY. 


391 


a twelfth  edition,  published  in  1869,  was  edited  by 
Dr.  Albert  H.  Smith. 

Ellis’  formulary  was  essentially  a compilation 
of  prescriptions  derived  from  the  writings  of  emi- 
nent physicians  in  America  and  Europe,  and  the 
numerous  editions  of  the  book  no  doubt  contributed 
materially  to  the  continuance  of  the  still  existing 
practice  of  copying  verbatim  the  prescription  of 
some  one  individual  for  all  or  nearly  all  affections 
of  a certain  type.  The  popularity  of  Ellis’  formu- 
lary led  to  the  compilation  of  a number  of  more  or 
less  original  books  of  popular  prescriptions  and  also 
to  the  republication  of  similar  collections  from 
England  and  the  Continent  of  Europe. 

The  popularity  accorded  to  the  prescriptions  of 
foreign  physicians  led  to  a demand  for  prepara- 
tions official  in  the  corresponding  pharmacopeias 
of  foreign  countries.  This  demand  was  met  by  the 
publication  of  an  American  edition  of  Mayne’s 
Dispensatory,  revised  by  Dr.  R.  Egelsfield  Grif- 
fiths. This  book  was  further  augmented  in  1850 
by  the  publication  of  Griffith’s  Universal  Formu- 
lary, which,  as  the  name  indicates,  was  compre- 
hensive indeed.  A second  edition  of  the  Universal 
Formulary,  edited  by  Dr.  Robert  P.  Thomas,  was 
published  in  1854.  This  edition  appears  to  have 
been  frequently  reprinted,  but  the  book  was  not 
issued  in  a revised  form  until  1873,  when  the 
third  edition,  edited  by  Prof.  John  M.  Maisch,  was 
published.  This  third  edition  includes  a note- 
worthy suggestion  of  the  evolution  of  our  present 
day,  so-called  ethical  proprietary  medicines,  the 
forerunners  of  which  are  to  be  found  in  the  elixirs, 
or,  perhaps  more  correctly,  the  cordial  elixirs, 
which  were  so  abused  during  the  decade  imme- 


302  PHARMACOPEIA  AM)  PHYSICIAN. 

diately  following  1870.  At  that  time  certain  manu- 
facturers made  use  of  the  fashion  that  seemed  to 
he  in  vogue  of  presenting  every  possible,  as  well  as 
impossible,  formula  or  combination  in  the  form  of 
an  elixir. 

As  an  important  development  we  have  the  Na- 
tional Formulary,  published  by  authority  of  the 
American  Pharmaceutical  Association.  The  his- 
tory of  this  volume  dates  back  to  1870,  when 
a committee  on  unofficial  formulae  was  appointed 
by  the  American  Pharmaceutical  Association. 
Little  of  practical  value  was  accomplished,  however, 
and  the  several  reports,  that  were  made  never  at- 
tained popularity,  because  they  were  buried  in 
the  official  reports  of  the  proceedings  of  the  asso- 
ciation. 

After  the  publication  of  the  Pharmacopeia  of 
1880  another  concerted  attempt  was  made  by  the 
American  Pharmaceutical  Association  to  compile 
an  unofficial  formulary.  Under  the  able  leadership 
of  the  late  Dr.  Charles  Rice,  of  New  York, 
a committee  presented  “a  preliminary  draft 
of  a national  formulary”,  in  1886  and  was 
able  to  issue  the  completed  book  in  1888.  The  sec- 
ond edition,  under  the  editorship  of  C.  Lewis 
Diehl,  the  present  chairman  of  the  committee  on 
National  Formulary  of  the  American  Pharmaceuti- 
cal Association,  was  published  in  1896.  and  the 
third  (1906)  edition,  or  the  second  revision,  has 
just  been  published. 

The  formulae  that  are  contained  in  the  211 
pages  of  this  last  edition  may  be  divided  into 
groups  consisting  of : 

1.  Formulae  from  former  editions  of  the  United 
States  Pharmacopeia.  These  have  been  gathered 


THE  NATIONAL  FORMULARY. 


393 


together  in  the  form  of  an  appendix  to  the  Na- 
tional Formulary  and  are  thus  readily  available  for 
easy  reference. 

2.  Formula?  official  in  foreign  pharmacopeias 
which  have  been  popularized  to  some  extent  in  this 
country  through  medical  literature,  but  not  suffi- 
ciently widely  used  to  warrant  their  being  included 
in  the  national  Pharmacopeia. 

Of  the  many  preparations  of  this  type  it  will 
suffice  to  enumerate  such  comparatively  well-known 
articles  as  Caffein  Sodio-Salicylate,  Ferrated  Ex- 
tract of  Apples,  Pectoral  Species,  Laxative  Species, 
Spirit  of  Formic  Acid  and  Ethereal  Tincture  of 
Ferric  Chloric!,  all  of  them  official  in  the  German 
pharmacopeia. 

3.  Formulae  introduced  by  prominent  medical 
men  or  teachers  that  are  either  of  comparatively 
recent  origin  or  of  restricted  use. 

This  class  of  formulae  is  perhaps  best  illustrated 
by  the  dermatologic  pastes  recommended  by  Lassar 
and  Unna,  for  which  a number  of  type  formulae 
are  included.  Among  other  formulae  that  may 
properly  come  under  this  heading  are  such  com- 
paratively well-known  empiric  preparations  as  Do- 
bell’s Solution,  Loomis’  Diarrhea  Mixture  and 
Squibb’s  Rhubarb  Mixture. 

4.  Formulae  representing  present-day  survivals 
of  the  old-time  “patent  medicines.” 

This  class,  although  no  longer  numerous,  is 
represented  by  such  well-known  titles  as  Turling- 
ton’s Balsam,  Dalby’s  Carminative,  Bateman’s 
Pectoral  Drops  and  Godfrey’s  Cordial. 

5.  Formulae  that  may  be  considered  to  repre- 
sent imitations  of  well-known  nostrums,  or  so- 
called  ethical  proprietary  remedies. 


394 


PHARMACOPEIA  AND  PHYSICIAN . 


As  noted  before,  this  is  a class  about  which 
there  exists  an  honest  difference  of  opinion.  When 
we  remember,  however,  that  the  most  meritorious 
of  these  several  nostrums  represent  very  little  that 
is  original  or  novel,  most  often  having  been  appro- 
priated from  the  prescriptions  of  well-known  phy- 
sicians, and  that  the  claims  that  are  made  in  con- 
nection with  many  of  them  are  based  largely  on 
extravagance  and  even  deception,  the  propriety  of 
using  supposed  imitations  of  any  of  them  presents 
itself  to  us  in  quite  a different  light. 

To  illustrate  how  very  little  originality  is  repre- 
sented by  the  average  proprietary  medicine  and 
how,  in  not  a few  cases,  the  discoverer  of  the  so- 
called  new  remedy  has  simply  succeeded  in  dis- 
guising an  old  and  well-known  formula  by  impart- 
ing to  it  a new  flavor,  giving  it  some  new  color  and 
conferring  on  it  a new  name,  we  refer  to  the  fol- 
lowing formulas  contained  in  this  late  edition  of 
the  National  Formulary : 

The  formula  for  “Alkaline  Antiseptic”  produces 
a preparation  that  is  suggestive  of  the  widely  ad- 
vertised proprietary  “Glyco-Thymoline.”  From  a 
therapeutic  point  of  view  this  formula  is  evidently 
based  on  the  old  and  widely  used  formula  for 
“Compound  Solution  of  Sodium  Borate” — Do- 
bell’s Solution — the  only  evident  difference  being 
the  substitution  of  the  aromatic  antiseptics  for 
the  “disagreeable”  carbolic  acid  and  imparting  to 
the  solution  a characteristic  color. 

In  the  National  Formulary  the  formula  for 
“Chloral  and  Brornid  Compound”  is  strongly  sug- 
gestive of  “Bromidia,”  but  it  also  calls  to  mind  the 
composition  of  the  very  much  older  and  well- 
known  English  formulae  for  chloroform  anodyne. 


THE  NATIONAL  FORMULARY. 


395 


chlor-anodyne  and  chlorodyne.  The  xlmerican  “dis- 
coverer/’ it  is  true,  has  substituted  for  the  compara- 
tively safe  chloroform  a huge  dose  of  hydrated 
chloral  and  calls  the  resulting  mixture  a safe  and 
harmless  one,  “the  hypnotic  par  excellence.”  Aside 
from  the  manifest  untruths  that  are  to  be  found 
in  the  advertising  matter  put  out  by  the  concern 
manufacturing  Bromidia,  and  the  pharmaceutical 
“knack”  in  preparing  it,  there  is  nothing  original 
or  novel  to  be  recorded  in  connection  with  it. 

The  Compound  Digestive  Elixir  recalls  the  still 
widely  used  Elixir  of  Lactopeptine,  which,  apart 
from  its  pretty  red  color  and  admittedly  pleasing 
taste,  and  enjoying  great  popularity  as  a general 
adjuvant,  has  little  to  recommend  it  therapeutic- 
ally. 

What  is  true  of  these  preparations  is  also  true 
of  nearly  all  this  class  of  mixtures  that  are  now 
being  exploited  and  sold  as  original  preparations; 
they  are  original  only  in  so  far  as  they  relate  to 
the  particular  manufacturer  or  his  individual  ideas 
and  represent  nothing  really  new  or  original. 

The  few  examples  enumerated  above  will  also 
serve  to  indicate  that  in  place  of  presenting  form- 
ulae for  imitations  of  proprietary  remedies  the  Na- 
tional Formulary  really  reflects  how  the  demands 
of  medical  practice  are  met  by  improved  pharmacy, 
to  which  the  manufacturers  of  proprietaries  have 
contributed  but  little. 

Apart  from  the  question  of  individual  right  in 
the  formula  or  the  composition  of  any  particular 
preparation  is  the  fact  that  practically  all  nostrums 
marketed  through  physicians  are  so  sold,  adver- 
tised, prescribed,  labeled,  etc.,  as  to  induce  self- 
medication  by  the  laity,  and  many  of  them  are  ad- 
vertised. at  least  indirectly,  to  the  public.  When 


390 


PHARMACOPEIA  AND  PHYSICIAN. 


we  remember  that  many  of  these  preparations  rep- 
resent dangerously  potent  drugs  and  that  all  of 
them  are  a menace  to  the  public  health  unless  their 
use  is  intelligently  directed,  we  must  admit  that 
as  physicians  we  have  been  sadly  remiss  in  our  duty 
as  guardians  of  the  public  "health  in  even  allowing, 
(to  say  nothing  of  fostering),  the  present-day  mul- 
tiplicity of  objectionable  nostrums. 

Even  in  connection  with  preparations  that  are 
otherwise  unobjectionable  it  is  possible  to  find 
really  serious  abuses  for  which  we  are  directly  re- 
sponsible. jSTot  a few  of  the  manufacturers  of 
medicinal  preparations  have  assumed  the  role  of 
scientific  investigators  and  attempt  at  least  to  pose 
as  such  before  us  and  before  the  public.  In  ex- 
ploiting their  wares,  however,  they  commonly  extol 
all  of  their  virtues,  but  either  minimize  their  dis- 
advantages or,  more  frequently,  omit  all  mention 
of  adverse  criticism.  We  would  instantly  discredit 
any  scientific  investigator  detected  in  such  decep- 
tion, and  if  manufacturers  continue  to  attempt  to 
pose  as  scientific  investigators  we  should,  in  jus- 
tice to  ourselves,  demand  the  same  standards  in 
the  exploitation  of  new  remedies  that  we  do  in 
scientific  research,  and  above  all  we  should  insist 
that  we  ourselves  are  not  misled  by  garbled  and  un- 
reliable reports  of  the  wonderful  cure-all  proper- 
ties of  a new  remedy. 

We  should  also  guard  against  the  imposition  of 
old  and  well-known  drugs  and  combinations  under 
fanciful  or  deceptive  trade  names  and  should  pro- 
tect our  patients,  the  pharmacists  and  ourselves 
against  the  evils  of  self-medication  by  always  em- 
ploying the  scientific  titles  in  preference  to  the 
trade  names  for  the  article  we  use  or  prescribe. 


INDEX 


[Heavy-face  figures  indicate  pages  on  which  subjects 
are  treated  at  greater  length  than  on  the  other  pages 
mentioned.] 


A.  C.  E.  mixture,  206. 

Acetanilid,  -50,  251,  252,  251, 
257,  385. 

Acetate  of  lead,  150. 

Acetates  of  sodium  and  potas- 
sium, 317. 

Aeetparaphenetidin,  251. 

.Aeetphenetidin.  251,  255. 

Acetum  opii,  241. 
scilke,  231. 

Acid  arsenous,  91. 
benzoic,  IS. 
boric,  45. 
cinnamic,  18. 
erotonoleic,  337. 
lactic,  258. 
ricinoleic,  337. 
tartaric,  343. 

Aeidum  arsenosum,  91. 
carbolicum,  26,  38,  202. 
hydriodicum  dilutum,  115. 
hydrochloricum,  59. 
hydrocyanicum  dilutum,  233. 
hypophospliorosum,  99. 
nitricum,  182. 
phosphoricum,  98. 
salicylicum,  40,  64,  6S. 
tannicum,  143,  370. 

Aconite,  199,  297. 
action  of.  298. 

Aconitin,  189,  199,  200,  299, 
300. 

amorphous,  299. 

Acorus  calamus,  127. 

Adeps  lanas  hydrosus,  .184. 

Adjuvant  elixir,  375. 

Adrenalin,  158,  190,  303. 

vEther,  218,  293. 

.Ethylis  carbamas,  262. 

.Ethylis  ehloridum,  217. 

Agurin,  313. 

Albuminate,  Marfori’s,  73. 

Albuminates,  metallic,  139. 

Albuminate  of  iron,  74,  76. 

Alcohol.  31,  161,  292. 

Alimentary  canal,  antisepsis  of, 
57. 

Alkaline  antiseptic,  394. 
antiseptic  tablet,  46. 


Alkalinity  of  blood,  317. 

Alkaloid  of  suprarenal  gland, 
156,  190,  281. 

Alkaloids,  precipitant  of,  142. 

Aloes,  327. 
and  iron  pills,  77. 

Aloinum,  327. 

Alteratives,  104. 

Alum,  151,  152,  370. 
as  a gargle,  46. 

Aluminum  sulphate,  152. 

American  wormseed,  356. 

Amido-phenol,  257. 

Ammonol,  250. 

Ammonia,  256,  315. 

Ammoniated  glycyrrhizin,  234. 

Ammonii  carbonas,  2:i5,  291. 
ehloridum,  226. 
iodidum,  116. 
salicylas,  6S. 

Ammonium  acetate,  85. 
carbamate,  291. 
carbonate,  235,  254,  291,  292. 
chlorid,  27,  43,  226,  292. 
citrate,  87. 
preparations,  291. 

Amyl  nitrite,  304. 

Amylene  hydrate,  261. 

Amylis  nitris,  304. 

Analgesics,'  237,  260. 

Analgesin,  251. 

Anemia,  S5,  94,  97,  103. 

Anesthesia,  injections  for  local, 
193. 

intraspinous  injections  for, 
. 104. 

Anesthetics,  general,  204. 
local,  188. 

Angina  pectoris,  303,  305. 

Anhvdromethylen  citric  acid, 
316. 

Anilin,  257. 
colors,  48. 

Anise  water,  373. 

Anodynes,  188,  232. 

Anthelmintics,  65,  354,  362. 

Anthracene,  324. 
derivatives,  325. 

Anthrachinone,  326. 


398 


PHARMACOPEIA  AND  PHYSICIAN. 


Antifebrin,  250. 

Antigonorrheics,  353,  365. 

Antikamnia,  250. 

Antimony,  £25. 
and  potassium  tartrate,  225. 

Antipyretics,  258. 
chemistry  of,  255. 

Antipyrin,  251,  255,  261,  373. 

Antisepsis,  32. 
intestinal,  57,  58. 
of  eye,  48. 

of  mucous  membranes,  44. 

Antiseptic  solution,  45. 

Antiseptics,  18,  58. 
and  disinfectants,  local,  32. 
chemical,  30. 
internal,  51. 

Antiseptol,  38. 

Apocynum,  276,  311. 

Apomorphin  hydrochlorid,  226, 
245. 

Appendicitis,  131,  323. 

Apples,  ferrated  extract  of,  393. 

Aqua  ammonia:,  291. 
amygdalae  amar®,  373. 
anisi,  373. 
camphor®,  289. 
cinnamoni,  373. 
fceniculi,  373. 
hamamelidis,  162. 
hydrogenii  dioxidi,  34. 
menthae  piperitae,  133,  374. 
menthae  viridis,  374. 

Arbutin,  316. 

Argenti  nitras,  155,  180,  367, 
370. 

nitras  fusus,  181. 
nitras  mitigatus,  181. 

Aristol,  38. 

Aristolochia  serpentaria,  12S. 

Aromatic  elixir,  255,  374,  375. 

Aromatics,  123. 

Arnica  montina,  162. 

Arseni  iodidum,  92. 
trioxidum,  91,  181. 

Arsenic,  89,  182. 
and  zinc  chlorid,  181. 
antidotes  for,  82. 
official  preparations  of,  91. 
solutions  of,  92. 
therapeutics  of,  94. 
trioxid,  91,  95,  181. 

Arsenous  acid,  1S2. 
iodid,  92. 

Artemesia  pauciflora,  355. 

Arteriosclerosis,  305. 

Asafetida,  134. 

Asagraaa  officinalis.  201,  302. 

Ascarides,  354,  358. 

Ascaris  lumbricoides,  356. 

Aspidium,  360,  361. 


Astringents,  138.  141,  146,  148. 

152. 

Atropa  belladonna,  196,  287. 
Atropin,  189,  196,  198,  248,  254. 
285,  298. 

indications  for,  287. 
sulphate,  196,  209,  287. 
Aurantii  amari  cortex,  127. 
Bacillus  putrificus,  53. 

typhosus,  58,  64. 

Bacteria,  effect  of  bile  on,  56. 

putrefactive,  59. 

Baking  soda,  178. 

Balsam  of  copaiba,  369. 
of  Peru,  37,  41,  228. 
of  tolu,  227. 

Barberry,  123. 

Basham’s  mixture,  81. 

Bateman’s  pectoral  drops,  393. 
Beebe’s  serum,  104. 

Belladonna  liniment,  198. 
ointment,  197. 
plaster,  197. 

Benzanilid,  257. 

Benzin,  206. 

Benzoic  acid,  18,  41,  189. 
Benzoinum,  228. 

Benzoyl  ecgonin,  189. 

Berberis  aquifolium,  123. 
Betanaphthol,  41,  61. 

Bichlorid  of  mercury,  23,  43. 
Bile,  328,  340. 

Biliousness,  58,  351. 

Biniodid  of  mercury,  43. 
Bioplasm,  349. 

Bismuth,  insoluble  salts  of,  147, 

148. 

subcarbonate.  61.  148,  149. 
subnitrate,  61,  148,  149. 
subgallate,  149. 
subsalicylate,  149. 

Bitter  almond  water,  373. 
Bitters,  125. 

Black  mustard,  168. 

Blackberry  root  bark,  146. 
Blaud’s  pills,  78,  86. 

Blindness  from  wood  alcohol, 
161. 

Blisters,  173. 

Bloodletting,  307. 

Bloodroot,  224. 

Blue  mass,  350. 
ointment,  44. 
stone,  154. 

vitriol.  24,  154,  181. 

Borax,  47. 

Boric  acid,  29,  37,  41.  45,  4S, 

153,  370. 

as  a gargle,  46. 
Bothriocephalus  latus,  359. 
Brandy,  162,  293. 

Bray  era,  362. 


IXDEX. 


399 


Bromid  group,  262. 

sodium  and  potassium,  260. 
Bromidia,  246,  259,  394,  395. 
Bromids,  233,  249. 

soluble,  375. 

Bromoform,  206. 

Bronchitis,  116,  166. 
acute,  221. 
chronic,  235. 

Brown  coloring,  381. 
mixture,  235. 

Burgundy  pitch,  plasters  of,  166. 
Bums,  48. 

Butyl  chloral  hydrate,  261. 
Caffein,  252,  254,  285,  288,  311, 
346. 

sodio-salieylate,  393. 

Calamus,  127. 

Calcii  hypophosphis,  99. 

Calcium  lactophosphate,  100. 
oxid,  22. 

Calendula  officinalis,  162. 
Calomel,  55,  58,  10S,  113,  314, 
336,  350,  357. 

Calumba,  122,  126. 

Calx,  22. 

chlorinata,  25. 

Cambogia,  337. 

Camphor,  173,  288,  291,  318. 
liniment,  289. 
monobromated,  263. 
water,  48,  153. 

Camphorated  soap  liniment,  163. 
Cancer  cures,  182. 

Cancerous  growths,  182. 

Cannabis  indica  245. 

Cantharidal  collodion,  175. 
Cantharides,  174,  317. 

cerate,  174. 

Cantharidin,  174. 

Capsicum,  166. 

fastigiatum,  166. 

Caramel,  381. 

Carbo  ligni,  169. 

Carbolic  acid,  19,  63,  202,  259. 

acid  as  disinfectant,  26. 
C'armin,  380. 

Carminative,  Dalby’s,  393. 
Carminatives,  130. 

Carvophyllus.  136. 

Cathartics,  320,  323,  350. 
anhvdrid  group  of,  333. 
drastic,  324. 
hydragogue,  325. 
saline,  341. 

saline  non-irritant,  324. 
vegetable,  325. 

Cascara  sagrada,  85,  332. 

Cassia  fistula,  339. 

Castor  fiber,  291. 

oil,  337. 

Castoria,  329. 

Caustics,  138,  ISO. 


Caustic  soda.  180. 

Cephaelis  ipecacuanha.  221. 
Ceratum  cantharidis,  174. 
resime,  165. 

Cerebral  excitement,  312. 

Chalk  mixthre,  145. 
Chamberlain’s  colic,  cholera, 
and  diarrhea  remedy,  135. 
Chapped  hands,  186. 

Charcoal,  169. 

Charta  sinapis,  168. 
Chenopodium  anthelminticum, 
356. 

Chimaphila,  316. 

Chirata,  123. 

Chloral,  209,  256. 
and  bromid  compound,  394. 
camphorated,  167. 
hydrate,  246. 

Chloralamid,  259,  261. 
Chloralose,  261. 

I Chloralum  hydratum,  260. 
Chlor-anodyne,  395. 

Chloretone,  261. 

Chlorid  of  lime,  25. 

of  zinc,  28. 

Chlorin,  25. 

Chlorodyne,  395. 

Chloroform,  36,  135,  163.  173, 
205,  207,  209,  21S,  260,  364. 
and  ether,  action  of,  211. 
anodyne,  394. 
liniment,  202. 

Chlorosis,  83,  95. 

Cholera  vibrio,  56. 

Cholin,  95. 

Chrysophanic  acid,  326. 
Cimicifuga,  125,  127. 

Cinchona,  65,  125,  128. 
Cinnamic  acids,  18,  41. 
Cinnamon  water,  373. 

Citrated  caffein,  313. 

Citrate,  iron  and  ammonium,  79. 
of  magnesia,  345. 
of  sodium  and  potassium,  317. 
Citric  acid,  313. 

Citrullus  eolocynthis,  334. 

Citrus  vulgaris,  127. 

Claviceps  purpurea,  295. 
Cleansing  of  hands,  33. 

Clinical  thermometers,  disin- 
fection of,  29. 

Cloves,  136. 

Coca,  192. 

Cocain,  30,  188,  190,  208. 
habit,  190. 

hydrochlorid,  149,  192. 
official  preparations  of,  192. 
Cochineal,  380. 

Cocoa  butter,  185. 

Cod  liver  oil,  102. 

liver  oil  emulsion.  103. 

Codein,  232,  243,  244. 


400 


PHARMACOPEIA  AND  PHYSICIAN. 


C'odein  phosphate,  2322,  244. 
sulphate,  232,  244. 

Coffee,  142,  312. 

Cold  bathing,  159. 

Cold  cream,  185. 
water,  laxative  action  of,  325. 

Colds,  190,  219,  300,  318. 

Collodium  cantharidatum,  174. 

Colocynthis,  334. 

Colon  bacillus,  53,  54. 

Colophony,  165. 

Coloring,  suggestive,  380. 

Compound  kino  powder,  144. 
mixture  of  glyeyrrhiza,  235. 
powder  of  morphin,  318. 
solution  of  cresol,  26. 
solution  of  iodin,  115. 
solution  of  sodium  borate,  394. 
syrup  of  hypophosphites,  100. 
syrup  of  sarsaparilla,  379. 
syrup  of  squill,  226,  231. 
syrup  of  white  pine,  224. 
tincture  of  cardamon,  377. 
tincture  of  lavender,  377. 

Confectio  sennae,  330. 

Constipation,  324,  330,  343,  351. 

Convallaria,  276. 

Convolvulus  seammonia,  334. 

Copaiba,  315,  369. 

Copper,  28. 
salts,  154. 

sulphate,  24,  28,  48,  181. 

Copperas,  24,  28. 

Corns,  180. 

Corrosive  mercuric  chlorid,  23, 
33,  43,  108,  353. 

Cotton  seed  oil,  185. 

Coughs,  219. 

Counter-irritants,  159,  172. 

Council  on  Pharmacy  and  Chem- 
istry, 17,  250,  387. 

Creolin,  26. 

Creosote,  32,  63,  65,  231. 

Cresol,  26,  29,  37,  39. 
compound  solution  of,  39. 
detergent  action  of,  40. 

Cresolin,  26. 

Crile’s  pneumatic  suit,  269. 

Croton  chloral  hydrate,  261. 
oil,  178,  179,  338. 
tiglium,  179,  338. 

Crotonoleic  acid,  178. 

Cubeb,  315. 

Cucurbita  pepo,  362. 

Cudbear,  381. 

Cumarin,  37. 

Cupri  sulphas,  24,  154,  181. 

Cusso,  362. 

Cystogen,  315. 

Dalby’s  carminative,  393. 

Datura  stramonium,  198. 

Delirium  cordis,  272. 

Demulcents,  159. 


Depressants,  circulatory,  297. 
Dermatol,  149. 

Dermatology',  41. 

Desiccated  suprarenal  glands, 
158. 

Deshler’s  salve,  165. 

Diabetes,  95. 

Diaphoresis,  317,  318. 
Diaphoretics,  290,  309,  31  7. 
Diarrhea,  55,  HO,  145,  146,  149, 
325,  338. 

Diet,  324. 

Diethylsulphonedimethvlmethane, 

261. 

Digitalin,  272,  274,  278,  279. 
German,  275. 

Digitalis,  266,  272,  277,  285,  294, 
310,  314. 

group,  therapeutic  action  of, 
276. 

purpurea,  274. 
tincture  of,  278. 
vasoconstrictor  effect  of,  306. 
Digitin,  274. 

Digitonin,  275,  278. 

Digitoxin,  271,  274,  278. 

Dionin,  245. 

Dioxymethyl  anthraquinone,  326. 
Diphtheria,  35. 

Disinfectants  and  antiseptics, 
local,  27,  32. 
chemical,  20,  21. 
general,  18. 

Disinfection,  47. 
moisture  needed  in,  25. 
of  bedrooms,  21. 
of  body,  34. 

of  cesspools,  drains,  urinals, 
cellars,  etc.,  23. 
of  clothing  and  instruments, 
33. 

of  corpses,  23. 
of  hands,  44. 

of  wounds  and  ulcers,  34. 
sheet  method  of,  21. 
Disulphonmethvlethvlmethane, 
262. 

Dithymol  diodid,  38. 

Diuresis,  312,  314. 

Diuretics,  309,  313,  317,  318. 
Diuretin,  313. 

Dobell’s  solution,  393,  394. 
Donovan’s  solution,  93. 
Dormiol,  261. 

Dover’s  powder,  222,  31S. 

powder  liquid,  243. 

Dropsy,  333. 

Dryopteris  felix-mas,  361. 

marginalis,  361. 

Dyspepsia,  95. 

fermentative,  60. 

Ecballium  elaterium,  335. 


INDEX. 


401 


Elaterin,  335. 

Elixir  adjuvans,  372,  375. 
aromaticum,  375. 
compound  digestive,  395. 
ferri,  quinin®  et  strychnin.'? 

phosphatum,  81. 
of  laetopeptine,  395. 
of  paregoric,  241. 
of  terpin  hydrate  and  codein 
sulphate,  229. 

Ellis’  medical  formulary,  390. 
Emetics,  153. 

Emodin,  326. 

Emollients,  159,  183. 
Emplastrum  belladonn®,  197. 
capsici,  166. 

Emulsion  of  castor  oil,  103,  338. 
Emulsum  asafoetid®,  134. 
chloroformi,  135. 
olei  morrhu®,  103. 

Epinephrjn,  158,  190. 

Epispastics,  173. 

Epsom  salts,  344. 

Ergot,  294. 

Ethacol,  232. 

Ether,  135,  205,  207,  2 18,  293, 
364. 

administration  of,  215. 
compound  spirit  of,  136. 
narcosis,  209. 

Ethereal  oil,  136. 

Ethyl  alcohol,  161. 
bromid,  206. 
carbamate,  258,  262. 
chlorid,  207,  210,  213,  217. 
morphin,  232. 
oxid,  293. 

Eucain,  30,  191. 

Eugenia  aromatica,  136. 
Euonymus,  335,  337. 

atropurpureus,  335. 

Europhen,  37. 

Exalgin,  257. 

Exanthemata,  36. 

Exogonium  purga,  333. 
Expectorants,  219. 
demulcent,  234. 
sedative,  221. 

Extract  of  belladonna  leaves, 
197. 

of  eolocynth,  compound,  334. 
of  ergot,  295. 
of  hematoxylon,  146. 
of  hyoscyamus,  238,  246. 
of  Indian  cannabis,  238. 
of  malt.  380. 
of  stramonium,  19S. 
of  witchhazel,' 162. 


Extractum  aloes,  327. 
cannabis  indie®,  246. 
digitalis,  275. 
gentian®,  121. 
glycyrrhiz®  purum,  234. 
leptandr®,  335. 
opii,  241. 

quassi®,  122,  356. 
rhamni  purshian®,  332. 
Extrapharmacopeial  substances, 
382. 

Fel  bovis,  340. 

Fellow’s  syrup,  98. 

Fennel  water,  373. 

Ferratin,  74. 

Ferri  carbonas  saceharatus,  78. 
et  ammonii  tartras,  79. 
et  potassii  tartras,  79. 
et  quinin®  citras,  80. 
et  strychninae  citras,  80. 
hydroxidum,  82. 
hypophosphas,  99. 

Ferric  chlorid,  152,  154. 
chlorid,  tincture  of,  86. 
citrate,  79,  85,  86. 
hypophosphite,  99. 
salts,  157. 
subsulphate,  152. 

Ferrous  carbonate,  78,  95. 
sulphate,  24,  28,  77,  85. 
sulphate,  dried,  77,  8b. 

Ferrum  reductum,  79. 

Ferula,  134. 

Fever,  malarial,  6S. 

Fig,  339. 

syrups,  329. 

Filicic  acid,  360. 

Flaxseed,  169. 

Fluidextract  of  blackberry  root 
bark,  146. 
of  geranium,  146. 
of  licorice  root,  234. 
of  red  rose,  146. 
of  rhus  glabra,  146. 
Fluidextraetum  aconiti,  200, 
299. 

apocyni,  276. 
aurantii  amari,  127. 
belladonnas  radicis,  197. 
berberis,  123. 
calami,  127. 
calumbas,  122. 
capsici,  166. 
chimaphil®,  317. 
chirat®,  123. 
cimieifug®,  128. 
cinehon®,  129. 
convallari®,  276. 
digitalis,  275. 
ergot®,  295. 
gentian®,  121. 
glycyrrhiz®,  234. 
granati,  361 . 


402 


PHARMACOPEIA  AND  PHYSICIAN . 


Fluidextractum  hydrastis,  128. 
ipecacuanhas,  222. 
leptandrae,  335. 
nucis  vomicae,  130. 
pilocarpi,  319. 
podophylli,  335. 
quassia,  122,  350. 
rhamni  purshianae,  332. 
sanguinariae,  224. 
scilla,  231. 
scopola,  248. 
senega,  224. 
senna,  329. 
serpentaria,  128. 
spigelia,  356. 
staphisagria,  354. 
stramonii,  198. 
uva  ursi,  316. 
veratri,  302. 
zingiberis,  131. 

Food  preservatives,  30. 

Foot  baths,  mustard,  168. 

Formaldehyd.  24,  30,  48,  315. 
solution,  29. 

Formic  acid,  171. 
aldehyd,  21. 

Fowler’s  solution,  93. 

Fracture  of  bones,  100. 

Fraenkel  solution,  209. 

Frangula,  326. 

Fraxinus  omus,  339. 

Friar’s  balsam,  228. 

Gadus  morrhua,  103. 

Gallic  acid,  146. 

Gambir,  140,  143. 

Gamboge,  337. 

Gangrene  from  phenol,  39. 

Garcinia  hanburii,  337. 

Gargles,  46. 

Gastric  juice,  56. 
ulcer,  147. 

Gastritis,  chronic,  156. 

Gentian  bitters,  125. 
and  orange  bitters,  125. 

Geranium,  146. 

German  pharmacopeia,  179. 

Ginger,  131. 

Glandulae  suprarenales  sicca, 
158. 

Glandulae  thyroidae  sicca,  118. 

Glonoin,  304. 

Glucose,  261. 

Glycerin,  24,  31,  42,  1S4.  1S6, 
370. 

magmas,  171. 

Glycerite  of  boroglycerin,  47. 
of  phenol,  203. 
of  starch,  42. 

Glyeeritum  acidi  tannici,  143. 
amyli,  42. 
boroglycerini,  47. 


Glyeeritum  ferri  quinas  et  strych- 
nin* phosphatum,  81. 
phenolis,  203. 

Glycerol,  184. 

Glycerophosphoric  acid,  100. 
Glyceryl  trinitrate,  304,  305. 
Glycothymoline,  394.- 
Glyeyrrhiza,  234. 
compound  mixture  of,  225. 
compound  powder  of,  352,  331. 
Glyeerrhizin,  372,  380. 
Glycyrrhizinum  ammoniatum, 
234. 

Godfrey’s  cordial,  393. 

Goiter,  hypoplastic  follicular, 
118. 

Golden  yellow  mixture,  381. 
Gonorrhea,  365,  369,  370. 
Goulard’s  extract,  151. 

Granatum,  361. 

Gray  powder,  107,  350,  351. 
Green  soap,  33. 

Griffith’s  pills,  78. 

Grindelia  robusta,  178. 

Guaiacol,  64,  65,  231. 

Guarana,  312. 

Hagenia  abyssinica,  362. 

Hay  fever,  188. 

fever  remedies,  190. 

Headache,  168,  254. 

Heart,  dilatation  of,  277. 
disease  of,  213. 
fatty  degeneration  of,  277. 
tonic,  264. 

Heat,  19,  169,  269. 

Helmitol,  316. 

Hematin,  75. 

Hematinics,  71. 

Hematogen,  73. 

Hematoxylon,  146. 

Hemdglobin,  75. 

Hemorrhage,  294. 

Hemorrhoids,  195,  198. 

Hemp,  Canadian,  2S1. 

Hernia,  strangulated,  323. 
Heroin,  245,  3S6. 
Hexamethylenamin,  64,  315, 

31S. 

History  of  Pharmacopeia,  7. 
Hive  syrup,  231. 

Hoffman’s  anodyne,  136,  293. 
Homatropin  hydroehlorid,  247. 
Hunyadi  water,  344. 

Huxam’s  tincture,  129. 
Hydrargyri  chloridum  corrosi- 
vum,  23,  43,  107. 
chloridum  mite,  10S,  350. 
iodidum  flavum,  107. 
iodidum  rubrum,  43,  107. 
Hydrargyrum,  106. 

cum  creta,  107,  350. 
Hydrastinin,  157. 

Hydrastis,  128. 


INDEX. 


403 


Hydrated  chloral,  237,  260,  307. 

Hydrazin,  256. 

Hydrobromic  acid,  263. 

Hydrobromids,  263. 

Hydroehinon,  316. 

Hydrochloric  acid,  56,  59. 
acid,  dilute,  59. 

Hydrocyanic  acid,  233. 

Hydrogen  dioxid,  29,  34,  45,  47, 
49,  59.  141. 

Hydroxybenzene,  38. 

Hydroxylamin,  256. 

Hyoscin,  248. 

Hyoscyaminas  sulphas,  249. 

Hypnal,  256,  261. 

Hypodermic  syringes,  29. 

Hypophosphites,  97.  101. 

Indian  cannabis,  245. 

Indigestion,  131,  351. 

Infectious  diseases,  spread  of. 
33. 

Inflammation  of  stomach.  147. 

Infusion  of  digitalis,  275. 
of  uva  ursi,  316. 

Infusum  digitalis,  275. 
sennas  compositum,  330. 

Injections,  intraspinous,  for  an- 
esthesia, 89,  193,  194. 

Insecticide,  44. 

Instrument  disinfection,  33. 
sterilization,  27. 

Intestinal  antiseptic,  56. 

Intestine,  closure  of,  323. 
spasmodic  constriction  of.  323. 

Introduction,  5. 

Iodids.  114,  249. 
soluble,  375. 

Iodin,  37.  3S,  62,  171.  172. 
compound  solution  of,  62, 
115,  171. 

Iodoform,  35,  36,  49. 
gauze.  37. 

Iodol,  37. 

Iodum,  62,  114. 

lodothyrin.  118. 

Ipecac,  221,  222. 

Iron,  71,  76. 
acid  albumin,  74. 
albuminate  of,  71,  76. 
and  ammonium  citrate,  87. 
and  quinin  citrate,  80. 
and  strychnin  citrate,  79. 
chlorid  of,  154. 
compound  mixture  of.  78. 
indications  for,  82. 
inorganic,  71,  74,  84. 
organic,  73. 
peptonate  of,  76. 
reduced,  79,  85. 
saccharated  carbonate  of,  78. 
salts,  154. 

scale  salts  of.  79,  87.  375. 

Irritants,  159,  314. 


Iso-punicin,  362. 

Jaborandi,  319. 

Jalap,  333,  336. 
powder,  compound,  336. 

Jamaica  quassia,  122,  356. 

Jateorhiza  palmata,  122. 

Juniperus  oxyeedrus,  41. 

Kairin,  258. 

Kamala,  360. 

Kataplasma  kaolini,  170. 

Kino,  143,  144. 

Kola,  312. 

Kopp’s  Baby’s  Friend,  135. 

Koso,  362. 

Kosotoxin,  360. 

Krameria,  143. 

Labarraque’s  solution,  26. 

Lactic  acid,  258. 

Laetophenin,  258. 

Lactucarium,  246. 

Lady  Webster’s  dinner  pill,  328. 

Lanolin,  184. 

Laudanum,  241. 
of  Sydenham,  241. 

Lauselcorner,  354. 

Laxatives.  331,  339,  350,  393. 

Lead  acetate,  153,  178. 
salts,  official,  150. 
subacetate,  solution  of,  150. 

Lecethin,  95. 

Leptandra,  335,  337. 

Leuein,  53. 

Licorice  root,  234. 

Lime,  22. 
liniment,  49. 
milk,  22. 

Linimentum  belladonna,  198. 
calcis,  49. 
camphorae,  289. 
chloroformi,  163. 
saponis,  163. 
terebinthinae,  165. 

Linseed,  169. 

Linum,  169. 

Liquid  carbolic  acid,  38. 
opodeldoc,  163. 
petrolatum,  185. 

Liquified  phenol,  38,  203. 

Liquor  acidi  arsenosi,  93. 
ammonii  acetatis,  319. 
antisepticus,  29,  45. 
arseni  et  hvdrargyri  iodidi, 
93. 

eresolis  compositus,  26,  39, 

48. 

ferri  chloridi,  154. 
ferri  et  ammonii  acetatis,  SI. 
ferri  sulphatis,  77. 
formaldehvdi,  21. 
hydrargyri  nitratis,  183. 
iodi  compositus,  62,  115,  171. 
magnesii  citratis,  345. 
plumbi  subacetatis,  151. 


404 


PHARMACOPEIA  AND  PHYSICIAN. 


Liquor  potassi  arsenitis,  - 93. 
potassii  citratis,  318. 
sodae  chlorinatse,  26. 
sodii  arsenatis,  93. 
sodii  phosphatis  compositus, 
347. 

zinc  et  alumini  compositus, 
26. 

zinc  et  ferri  compositus,  26. 
Lithii  carbonas,  348. 

citras  effervescens,  348. 
Lithium  salicylate,  348. 
Loganiaceae,  283. 

Loomis  diarrhea  mixture,  393. 
Loretin,  37,  38. 

Losophan,  37,  38. 

Lugol’s  solution.  62,  171. 
Lumbago,  198. 

Lunar  caustic,  180. 
Lymphosarcoma,  95. 

Lysol,  26. 

McMunn’s  elixir  of  opium,  242. 
Magnesii  carbonas,  344. 
oxidum,  344. 

Magnesium  sulphate,  208,  330. 

sulphate,  effervescent,  343. 
Male  fern,  359. 

Mandrake  root,  335. 

Manganese,  87,  88. 
dioxid,  precipitated,  89. 
hypophosphite,  99. 
preparations,  peptonized,  88. 
Mangani  dioxidum  praecipita- 
tum,  89. 

hypophosphis,  99. 
sulphas,  89. 

Manna,  330,  339,  340. 

Massa  ferri  carbonatis,  78. 

hydrargyri,  107,  350. 

Matico,  315. 

May  apples,  335. 

Medicated  waters,  373. 
Menstruation,  253. 

Mentha  piperita,  132,  167. 

viridis,  133. 

Menthol,  167,  173. 

Mercurial  ointment,  353. 
Mercurials,  43,  105,  • 106,  10S. 
Mercuric  ehlorid,  23,  27,  33, 

43,  44,  48,  10S,  1S2,  353. 
iodid,  111. 
nitrate,  183. 
oxid,  red,  44,  353. 
salicylate,  113. 

Mercurous  ehlorid,  mild,  5S, 
108,  113,  350. 
iodid,  111. 
iodid,  yellow,  107. 

Mercury,  106. 

hypodermic  injection  of,  113. 
in  pregnancy.  111. 
with  chalk,  107,  350. 
Methemoglobin,  253,  303. 


Methyl  aeetanilid,  257. 
alcohol,  161. 
punicin,  362. 
salicylate,  173. 

Mineral  acids,  27. 

Mints,  official,  132. 

Mistura  cretae,  145. 
ferri  composita,  78. 
sodae  et  menthae,  133. 

Mitral  stenosis,  277. 

Mixture  for  general  anesthesia, 
207. 

Monsel’s  solution,  77. 

Morphin,  195,  232,  240,  239, 

243,  260,  270,  282,  285. 
habit,  347. 
sulphate,  373. 

Morphinae  acetas,  243. 

Morphinae  hydrochloridum,  244. 
Morphinae  sulphas,  244. 

Moschus  moschiferus,  290. 
Mouth  wash,  35. 

M.  S.  mixture,  207. 

Mucilage  of  acacia,  234,  379. 

of  tragacantli,  1S4,  379. 
Mucous  membrane  antisepsis, 
44. 

membranes,  local  treatment 
of,  151. 

Muriatic  acid,  59, 

Muscarin,  28S. 

Musk,  290. 

Mustard,  137,  174. 
paper,  168. 
poultice,  169. 

Mydriaties,  247. 

Myocardium,  improved  nutri- 
tion of  the.  267. 

Myxedema,  118. 

Naphthalen,  41,  56,  60,  364. 
Naphthol,  41,  61. 

Nasal  passage  antisepsis.  46. 
National  Formulary',  382. 
Nephritis,  174,  310,  314. 

Nerves  in  teeth,  destruction  of, 
182. 

Neuralgia,  167,  198,  201. 

New  remedies,  dangers  from, 
3S4. 

Xiemeyer’s  pills,  310. 

Nitrates,  302. 

Nitric  acid,  182. 

Nitrites,  303,  305,  307. 
Nitroglycerin,  304. 

Nitrous  oxid,  204. 

Norwood’s  tincture  of  veratrum, 
301. 

Nosophen,  37. 

Nuclein,  95. 

Nutmeg,  137. 

Nux  vomica,  86,  130,  283. 
Obesity,  104,  118. 

Obstetricians,  213. 


INDEX. 


405 


Oil  of  almonds,  expressed,  185, 
337. 

of  American  worm  seed,  358. 
of  cade,  41. 
camphorated,  289. 
carron,  49. 
castor,  337. 

of  chenopodium,  356,  358. 
of  cinnamon,  137. 
of  cloves,  164. 
of  copaiba,  164,  369. 
cotton  seed,  185,  337. 
croton,  337. 
of  cubeb,  369. 
ethereal,  136. 
of  juniper,  315. 
of  juniper  tar,  41. 
of  mustard,  volatile,  164. 
olive,  185,  337. 
of  pennyroyal,  164. 
petroleum,  104.  . 
purgative,  337. 
of  sandalwood,  164,  368. 
of  santal,  368. 
of  savin,  165. 
of  theobroma,  185. 
of  thymus  vulgaris,  40. 
of  turpentine,  165,  315. 
of  turpentine,  rectified,  364. 
volatile,  45,  123,  164,  315. 
of  wintergreen,  69. 

Ointment  of  ammoniated  mer- 
cury, 183. 
carbolic,  354. 
of  mercuric  nitrate,  1S3. 
of  mercury,  44. 
of  phenol,  203. 
of  red  mercuric  oxid,  44. 
of  red  precipitate,  44. 
of  rose  water,  185. 
stramonium,  198. 
of  sulphur,  42. 
of  tar,  41. 

Oleate  of  atropin,  197. 
of  eocain,  192. 
of  veratrin,  201. 

Oleoresin,  359. 
of  aspidium,  361,  364. 

Oleoresina  capsici,  167. 
cubebae,  369. 
zingiberis,  132. 

Oleum  amygdalae  expressum, 
185. 

betulae,  69. 
cadinum,  41. 
caryophylli,  136. 
chenopodii,  356. 
copaibae,  369. 
gaultherias,  69. 
gossypii  seminis,  185. 
jecoris  aselli,  103. 
menthae  piperitae,  132. 
morrhuae,  103. 


Oleum  olivae,  185. 
ricini,  337. 
rosmarini,  165. 
sabinae,  165. 
santali,  368. 
sinapis  volatile,  168. 
trebinthinae,  165. 
theobromatis,  185. 
tiglii,  179,  33S. 
vitroli  dulce,  293. 

Opii  pulvis,  240. 

Opium,  146,  195,  238,  339,  270, 
323. 

deodoratum,  240. 
deodorized  tincture  of,  242. 
McMunn’s  elixir  of,  242. 
official  preparations  of,  239. 
poisoning,  288. 

Orange  and  gentian  bitters,  125. 
peel,  bitter,  127. 

Osteomalacia,  100. 

Ourouparia  gambir,  144.' 

Ovis  aries,  iS4. 

Oxyanthraquinone,  326. 

Oxyuris  yermicularis,  358. 

Packer’s  tar  soap,  176. 

Para-amido-phenol,  257. 

Paraldehyd,  259,  261. 

Paralysis,  local  intestinal,  323. 

Parasitic  fungi,  42,__ 

Parasiticides,  44,  353. 

Paregoric,  241. 

Parenchymatous  nephritis, 
chronic,  351. 

Patent  medicines  for  coughs,  219. 

Peacock’s  bromids,  263. 

Pearls  of  amyl  nitrite,  307. 

Pearson’s  solution,  93. 

Pectoral  species,  393. 

Pediculi,  44. 

Pediculus  pubis,  353. 

Pelletierin,  359,  360. 
tannate,  361. 

Penicillium  brevicaule,  89. 

Pepo,  362. 

Pepper,  137. 

Peppermint,  132,  133. 
water,  374. 

Peptomangan-Gude,  88. 

Peptonate  of  iron,  76. 

Peptonized  manganese  prepara- 
tions, 88. 

Periostitis,  116. 

Peristalsis,  55,  59,  322. 

Peritonitis,  131,  323. 

Peru  balsam,  37. 

Petrolatum,  184. 
album,  185. 
liquidum,  185. 

Petroleum  ether,  206. 
oils,  104. 
saponated,  172. 

Pharmacopeia,  5. 


406 


PHARMACOPEIA  AND  PHYSICIAN. 


Phenacetin,  251,  255,  257. 
Phenalgin,  250. 

Phenetidin,  257. 

Phenocoll,  258. 

Phenol,  19,  26,  29,  32,  38,  63, 
189,  202,  257,  359,  370. 
Phenolphthalein,  341. 
Phenolsulphonic  acid,  63. 
Phenylaeetamid,  250,  257. 
Phenyl-dimethyl-pyrazolon,  251. 
Phenylhydrazin,  256. 

Phenyl  salicylate,  64,  69. 
Phosgene,  208. 

Phosphates,  97. 
of  iron,  quinin  and  strychnin, 
81. 

Phosphoric  acid,  99. 

Phosphorus,  95,  96,  98,  101. 
and  its  salts,  therapeutics  of, 
100. 

Phthisis,  97. 

Picrasma  excelsa,  122,  356. 
Picrol,  38. 

Pills  of  aloes  and  iron,  77,  85, 
328. 

of  aloes  and  mastic,  328. 
of  aloes  and  mvrrh,  328. 
Blaud’s,  78,  86. 
compound  cathartic,  336. 
Connecticut,  390. 
of  ferrous  carbonate  and 
potassium  sulphate,  78,  86. 
Francis’,  337. 

Griffith’s,  78,  86. 

Lady  Webster’s  dinner,  32S. 
of  lead  and  opium,  147. 
Lee’s,  390. 

of  rhubarb,  compound,  328. 
triplex,  337. 

Vallet’s,  78. 

vegetable  cathartic,  328,  334. 
Pilocarpin,  288,  318. 

nitrate,  319. 

Pilocarpus,  318,  319. 
aloes  et  ferri,  77. 
asafostid®,  134. 
cathartic®  composite,  334. 
ferri  carbonatis,  78. 
laxative  composite,  327. 
opii,  241. 
phosphori,  98. 

Pink  root,  356,  35S. 

Pinus,  41,  165. 

palustris,  165. 

Pipsissewa,  316. 

Pix  liquida,  41. 

Plasters,  resin,  166. 

rubefacient,  166. 
rlumbi  acetatis,  150. 
Podophyllum,  335,  336. 

Poison  oak,  178. 

Polygala  senega,  224. 
Pomegranate,  361 . 


Pomegranate  root  bark,  363. 
Potassa,  180. 

Potassii  chloras,  45. 
et  sodii  tartras,  345. 
hypophosphas,  99. 
iodidum,  116. 

permanganas,  49,  89,  367. 
Potassium  and  antimony  tar- 
trate, 179,  226. 
bicarbonate,  133. 
bitartrate,  336. 
bromid,  237,  238,  262,  312. 
chlorate,  45. 
citrate,  318,  373. 
hydroxid,  180. 
hypophosphite,  99. 
iodid,  106,  111,  263. 
permanganate,  27,  49,  59. 
sulphate,  152. 
tartrate,  225. 

Poultices,  169. 

Powder,  antiseptic  astringent, 
48. 

compound  of  glyeyrrhiza,  331. 
352. 

Dover’s,  222,  318. 
of  ipecac,  318. 
of  ipecac  and  opium,  222. 
of  opium,  318. 

Powdered  blue  mass,  107. 
Precipitate,  red,  353. 

Pregnancy,  use  of  mercurials  in, 
351. 

Preservatives,  31. 

Probilin,  341. 

Protozoon,  6S. 

Prune,  339. 

Pseudo-punicin,  362. 

Pterocarpus  marsupium,  144. 
Pulvis  acetanilidi  compositus, 
250. 

glyeyrrhiz®  compositus,  235, 
330. 

iodoformi  compositus,  37. 
ipecacuanhas  et  opii,  222, 
243. 

jalap®  compositus,  333. 
morphin®  compositus,  318. 
Pumpkin  seed,  360,  364. 

Punica  granatum,  361,  362. 
Punicin,  362. 

Purgatives,  324. 

irritant,  55. 

Pustulants,  178. 

Pyoktannin,  4S. 

Pyrogallic  acid,  40. 

Pyrogallol,  40. 

Quassia,  122,  356. 

Quassia  amara,  122,  356. 
Quinin,  51,  65,  255. 

Quinin®  bisulphas,  66. 
hydrobromidum,  66. 
hydrochloridum,  66. 


INDEX. 


407 


Quininas  salicylas,  66. 

sulphas,  66. 

Quinolin,  38,  255. 

Red  coloring,  381. 
iodid,  112. 

mercuric  iodid,  43,  107. 
wine,  378. 

Reduced  iron,  85. 

Remedies,  new,  383. 

Resin  of  jalap,  333,  336. 
of  seammony,  335. 
plasters,  166. 

Resina,  165. 

podophylli,  335. 

Resorcin,  40,  259. 

Resorcinol,  40,  259. 

Rhamnus  purshiana,  332. 

Rheum,  331. 

Rheumagon,  347. 

Rheumatism,  201. 

chronic,  117. 

Rhubarb,  326,  331. 

official  preparations  of,  331. 
Rhus  glabra,  146. 

poisoning,  177. 

Ricinus  communis,  337. 

Rickets,  100,  104. 

Rochelle  salts,  345. 

Rose  water,  187. 

Rosin,  165. 

Rosmarinus  officinalis,  165. 
Rubefacient  plasters,  166. 
Rubefacients,  160. 

Rubus,  146. 

Rumex,  326. 

Sacred  bark,  332. 

Salacetin,  250. 

Sal  alembroth,  43. 
ammoniac,  226. 
hepatica,  349. 

Salicin,  69. 

Salicylates  in  rheumatism,  68. 
Salicylic  acid,  30,  40,  41,  257, 
259. 

Saline  cathartics,  341. 

purgatives,  321,  325. 
Salipyrin,  257. 

Sal-lithin,  349. 

Salol,  64,  328. 

Salophen,  258. 

Salt,  common,  47. 

solution,  physiologie,  269. 
Salts,  purgative,  344. 

Rochelle,  345. 

Sanguinaria,  224. 

Sanguinarin,  224. 

Santalol,  369. 

Santalum  album,  368. 

Santonin,  355,  357. 

Sarsaparilla,  compound  svrup  of, 
330. 

Scalds,  48. 

Seammony,  334,  336. 


Schleich’s  infiltration  method, 
195. 

Scilla,  230. 

Scoparin,  314. 

Scoparius,  314. 

Scopola,  248. 

carniolica,  248. 
Scopolamin-morphin  solution, 
208. 

Scopolamine  hvdrobromidum, 

248. 

Semen  staphidis  pedicularis, 
354. 

Senega,  224. 

Senna,  326,  329,  358. 
Serpentaria,  125,  12S. 

Serum  of  Beebe,  104. 

Shock,  268,  280,  284,  287,  289, 
294. 

Silver,  155. 
iodid,  368. 

nitrate,  48,  155,  180,  370. 
nitrate,  mitigated,  181. 

Sinapis  alba,  168. 

nigra,  16S. 

Slippery  elm,  169. 

Smelling  salts,  292. 

Soap  liniment,  163. 
liniment,  camphorated,  163. 
Packer’s  tar,  176. 

Soda,  21. 

Sodii  arsenas,  92. 
arsenas  exsiccatus,  92. 
hypophosphis,  99. 
nitris,  304. 

Sodium  acetate,  313. 
benzoate,  312,  373. 
bicarbonate,  46,  133,  178. 
borate,  47,  48. 
bromid,  255. 
chlorid,  27,  47.  269. 
hyposulphite,  42. 
iodid,  347. 
nitrate,  304. 

phenolsulphonate,  47,  63. 
phosphate,  346. 
salicylate,  68,  312,  313,  373. 
santoninate,  355. 
sulphocarbolate,  47,  63. 
thiosulphate,  42,  172. 
Solution,  alkaline  antiseptic,  45. 
of  arsenous  acid,  93. 
of  chlorinated  soda,  26. 
Donovan’s,  93. 
of  ferric  chlorid,  77. 
of  formaldehyd,  21. 

Fowler’s,  93. 

Fraenkel’s,  209. 
of  hydrogen  dioxid,  34. 
of  iodin,  compound,  62. 
of  iron  and  ammonium 
acetate,  81. 

Lugol’s,  62. 


408 


1'llARMACOPEIA  AND  PHYSICIAN. 


Solution,  Monsel’s,  77. 

Pearson’s,  93. 
of  potassium  arsenite,  93. 
of  potassium  citrate,  318. 
of  sodium  arsenate,  93. 

Soporifics,  237. 

Sore  throat,  35. 

Sozoiodol,  38. 

Spanish  flies,  174. 

Spartein,  314. 

Spartinae  sulphas,  314. 

Spearmint,  133. 
water,  374. 

Spigelia,  356,  358. 
marilandica,  356. 

Spirit  of  ammonia,  292. 
of  anise,  375. 
of  bitter  almonds,  375. 
of  cinnamon,  376. 
distilled,  292. 
of  ether,  295. 
of  formic  acid,  393. 
of  gaultheria,  376. 
of  glyceryl  trinitrate,  306. 
of  minderevus,  319. 
of  niter,  sweet.  319. 
of  nitroglycerin,  306. 
of  nitrous  ether,  306. 
of  peppermint,  133,  376. 
of  spearmint,  376. 

Spiritus  aetheris,  136,  293. 
aetheris  compositus,  136,  293. 
aetheris  nitrosi,  319. 
ammoniae  aromaticus,  292. 
amygdalae  amara,  375. 
camphors,  163,  289. 
chloroformi,  135. 
frumenti,  162,  293. 
gaultheriae,  163,  376. 
glonoini,  304. 
glycerylis  nitratis,  304. 
menthae  piperitae,  132,  376. 
menthae  viridis,  376. 
villi  gallici,  162,  293. 

Splanchnic  area,  2S6. 

Squibb’ s rhubarb  mixture,  393. 

Squill,  230,  310,  314. 

Staphisagria,  353. 

Steam,  moist,  21. 

Sterilization  of  hypodermic  so- 
lutions, 29. 

of  surgical  instruments,  27. 

Stimulant,  cardiac,  285,  311. 
circulatory,  264,  276. 
respiratory,  284. 

Stimulation,  mechanism  of,  265. 
of  constrictor  mechanism,  269. 

Stomachics,  70.  11S. 

Stovain,  30,  191. 

Stramonium  ointment,  19S. 

Strontii  iodidum,  116. 
salieylas,  69. 


Strontium  salts,  263. 

Strophanthin,  272,  275,  279. 
as  local  anesthetic,  311. 

Strophanthus,  272,  275,  311. 
kombe,  275. 
seed,  280. 

Strychnin,  281,  288,  294. 
vasoconstrictor  effect  of,  306. 
nitrate,  284. 
sulphate,  283. 

Strychnos  nux  vomica,  130. 

Styptics,  157. 

Sugar,  31. 
of  lead,  151. 
of  milk,  314. 

Sulphonal,  259,  261. 

Sulphonethylmethane,  259,  261. 

Sulphonmethane,  259,  261. 

Sulphur  lotum,  42,  351. 
ointment,  42. 
precipitatum,  42,  351. 
sublimatum,  24,  42,  351. 
washed,  42. 

Sulphuric  ether,  135,  293. 

Sulphurous  oxid,  24. 

Sumbul  root,  291. 

Sunburn,  186. 

Sunlight  and  heat,  19. 

Supersaturated  air,  21. 

Suppositories,  198. 

Suprarenal  gland,  desiccated, 
157,  158. 

Suprarenin,  158. 

Surgical  dressings,  35. 

Sweet  flag,  127. 

Swertia  chirayita.  123. 

Synthetics,  introduction  of,  15. 

Syphilis,  109. 
tertiary,  116. 

Svrup  of  blackberry  root  bark, 
146. 

of  citric  acid,  378. 

Fellow’s,  98. 
of  hydriodic  acid,  115. 
of  liypophosphites.  compound, 
100. 

of  iodid  of  iron,  116. 
of  ipecac,  222. 
of  orange,  378. 
of  red  rose,  146. 
of  senna,  357. 
of  squill,  230. 
of  squill,  compound,  226. 
of  tar,  229,  233. 
of  tolu,  227,  22S.  37S. 
of  white  pine,  225. 
of  wild  cherry,  378. 

Syrupus  acaciae,  234.  379. 
calcii  lactophosphatis,  100. 
ferri,  quininae  et  strychinnae 
phosphatum,  81. 
lactucarii,  247. 
picis  liquids,  229. 


INDEX. 


409 


Syrupus  pruni  virgihianae,  378. 
"sarsaparillae  compositus,  379. 
senegae,  224. 

Tablets,  soda  mint,  133. 

Taenia  inermis,  360. 
saginata,  359. 
serrata,  360. 
solium,  359. 

Talcum,  41. 

Tamar-Indien,  330. 

Tamarindus,  339,. 

Tannate  ot  pelletierin,  362. 

Tannic  acid,  141,  370. 

Tannin,  139,  156.  363. 

Tapeworm,  361,  363. 

Tar,  32,  41. 
ointment,  41. 
soap,  353. 

Tartar  emetic,  178,  179,  226. 

Tea,  142,  312,  313. 

Teeth,  carious,  195. 

Teniafuges,  354,  359,  362. 
official  substances  used  as, 
361. 

Tenicides,  354. 

Terebene,  230. 

Terebinthina,  165. 

Terpin  hydrate,  229. 

Tetra-iodopvrrol,  37. 

Thallin,  259. 

Thea  sinesis,  313. 

Thebaica,  240. 

Theobromin,  285,  312. 
sodium,  313. 

Thermometers,  clinical,  disin- 
fection of,  29. 

Thermo-cauterv,  ISO. 

Thymol,  40,  63,  65,  364,  370. 
iodid,  38,  40. 

Thymus  vulgaris,  oil  of,  40. 

Thyroid  gland,  104,  11S. 
disease,  104. 

Tinctura  aconiti,  200,  299. 
amieae,  162. 
asafoetidae,  134. 
aurantii  amari,  127. 
aurantii  dulcis,  376. 
benzoini  composita,  228. 
calendula?,  162. 
calumbae,  122. 
cannabis  indicae,  246. 
cantharidis,  175. 
eapsici,  167. 

cardamomi  composita,  129, 
377,  381. 
eimieifugae,  128. 
cinchona,  129. 
cinehonae  composita,  129. 
digitalis,  275. 
ferri  chloridi,  77,  154. 
gambir  composita,  144,  149. 
gentianae  composita,  121. 
hydrastis,  128. 


Tinctura  iodi,  62,  115,  171. 
ipeeacuanhae  et  opii,  243. 
kino,  144,  147,  149. 
lactucarii,  246. 
lavandulae  composita,  377. 
moschi,  290. 
nucis  vomicae,  130,  374. 
opii,  241. 

opii  camphorata,  241. 
opii  deodorati,  242. 
quassiae,  123,  356. 
scillae,  231. 
serpentariae,  128. 
strophanthi,  275. 
tolutana,  227. 
vanillae,  377. 
veratri,  302. 
zingiberis,  131. 

Tincture  of  aloes,  32S,  329. 
of  aloes  and  myrrh,  32S. 
of  calumba,  374. 
of  cardamon,  377. 
of  cudbear,  381. 
of  ferric  chlorid,  ethereal, 
393. 

Huxam’s,  129. 
of  krarneria,  145,  147,  149. 
of  larkspur,  353. 
of  soap,  camphorated,  163. 
of  stavesaere,  353. 
of  sweet  orange  peel,  372, 
376. 

of  thebaica,  240. 

Toluifera  balsamum,  227. 

Tonics,  general,  70. 
Toxicodendrol,  177. 

Toxicology  of.  strychnin,  283. 
Tri-iodomethane.  35. 

Trional,  259,  261. 
Trioxymetholanthraquinone.  326. 
Trochisei  acidi  tanniei,  143. 
ammonii  chloridi,  227. 
gambir,  144. 

glycyrrhizae  et  opii,  234,  243. 
Tubercle  bacillus,  56. 
Tuberculosis,  95,  97,  101,  103, 

351. 

Turlington’s  balsam,  22S,  393. 
Turpentine,  173. 

Typhoid  bacilli,  20,  2S,  os. 

fever,  62. 

Tvrosin,  53. 

Ulcerations  of  throat,  152. 
Ulcers,  49,  149. 

Ulmus,  169. 
fulva,  169. 

Unguentum  aquae  rosae,  185. 
belladonnas,  197. 
hydrargyri,  44. 
hydrargvri  ammoniati,  183. 
hydrargyri  nitratis,  183. 
hydrargyri  oxidi  rubri,  44. 
iodi,  171. 


410 


PHARMACOPEIA  AND  PHYSICIAN. 


Unguentum  phenolis,  203. 
picis  liquid*,  41. 
stramonii,  198. 
sulphuris,  42. 
veratrin*,  201. 

United  States  Pharmacopeia,  5. 

Urea,  314. 

Urethane,  258,  2G2 

Urginea  maritima,  230. 

Uric  acid  solvent,  348. 

Uriform,  316. 

Urine  discoloration  from  phenol, 
39. 

Urotropin,  315. 

Uva  ursi.  316. 

Vallet’s  mass,  78. 
pills,  78. 

Vasoconstriction,  280,  311,  313. 

Vasoconstrictors,  156. 

Vasomotor  spasm,  305. 

Vegetable  calomel,  336. 
infusions,  318. 

Vehicles,  substances  used  as, 
371. 

Veratrin,  199,  201,  302. 
ointment,  201. 

Veratrum,  301. 
viride,  301. 

Vermicides,  354. 

Vermifuges,  354. 

Vesication,  173,  174. 

Vesicants,  173. 

Vinegar  of  opium,  241. 
of  squill,  231. 


Vinum  album,  377. 
antimonii,  225. 
ergot*,  295. 
ferri,  80. 

ferri  amarum,  80. 
ipeeacuanh*,  222. 
opii,  241. 
rubrum,  378. 

Vioform,  37. 

Virginia  snakeroot,  128. 

Vitis  vinifera,  377,  378. 

Volatile  oils,  31,  45. 

Warts,  180,  183. 

Whisky,  162. 

White  mustard,  168. 

Wine  of  ipecac,  222. 
of  iron,  bitter,  87. 
white,  377. 

Winslow’s  Soothing  Syrup,  Mrs. 
135. 

Wintergreen,  376. 

Witchhazel  extract,  162. 

Yellow  mercurous  iodid,  107. 
Zinc  acetate,  154,  369. 
and  arsenic  chlorid,  181. 
chlorid,  48,  182,  370. 
oxid,  41,  154. 

phenolsulphonate,  63,  152 

153,  370. 

salts,  use  of,  152. 
sulphate,  152,  369. 
sulphocarbolate,  153. 

Zingiber,  131. 


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